Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A17533 | CA |
NPI | 1013025071 |
---|---|
Provider Name | Dr. Wendell Blake Jamison |
First Address | Lompoc, CA 93436 |
Second Address | Lompoc, CA 93436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B49870 | (02) |