Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | MD015498E | PA |
NPI | 1124079272 |
---|---|
Provider Name | Jerry D Jamison |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Allentown, PA 18102-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03197 | (02) |