Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 0101241309 | VA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 13192 | SD |
NPI | 1073564993 |
---|---|
Provider Name | Mark James Jameson |
First Address | Sioux Falls, SD 57105-1062 |
Second Address | Sioux Falls, SD 57105-1062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 01/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0487819 | (05) | IA |
1073564993 | (05) | VA |
20003 | WELLMARK BCBS (01) | IA |
P00347197 | MEDICARE RAILROAD (01) | IA |