Provider Demographics
NPI:1730450008
Name:JAMISON ALEXANDER DO PA
Entity type:Organization
Organization Name:JAMISON ALEXANDER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-892-8222
Mailing Address - Street 1:3401 N CALAIS
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-3104
Mailing Address - Country:US
Mailing Address - Phone:903-892-8222
Mailing Address - Fax:903-892-8444
Practice Address - Street 1:3401 N CALAIS
Practice Address - Street 2:SUITE B
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3104
Practice Address - Country:US
Practice Address - Phone:903-892-8222
Practice Address - Fax:903-892-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2939910-01Medicaid