Provider Demographics
NPI:1548260995
Name:JESTER, BETH A (MD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:JESTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:STE N9B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2111
Mailing Address - Country:US
Mailing Address - Phone:505-292-5850
Mailing Address - Fax:505-292-9724
Practice Address - Street 1:8316 KASEMAN CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7639
Practice Address - Country:US
Practice Address - Phone:505-292-5850
Practice Address - Fax:505-292-9724
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2019-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA65180207N00000X
IL036-094530207N00000X
NMMD 2004-0502207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70140Medicare UPIN