Provider Demographics
NPI:1538195938
Name:JESSURUN, CARLOS RUBEN (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RUBEN
Last Name:JESSURUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1420
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-797-1620
Mailing Address - Fax:713-797-1543
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-797-1620
Practice Address - Fax:713-797-1543
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMDJ2112207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124503701Medicaid
TX060056695OtherRR
TXG45000Medicare UPIN
TX124503701Medicaid