Provider Demographics
NPI:1497199400
Name:RUEB, JESSICA JACKSON (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JACKSON
Last Name:RUEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA JACKSON
Mailing Address - Street 1:115 MIDLANDS CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3456
Mailing Address - Country:US
Mailing Address - Phone:803-312-4814
Mailing Address - Fax:803-457-7001
Practice Address - Street 1:115 MIDLANDS CT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3456
Practice Address - Country:US
Practice Address - Phone:803-457-7000
Practice Address - Fax:803-457-7001
Is Sole Proprietor?:No
Enumeration Date:2013-04-20
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351342722088F0040X, 2088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC83767OtherU FPRS