Provider Demographics
NPI:1083616502
Name:JAMESON, DAVID BRYCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRYCE
Last Name:JAMESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 - 126TH ROAD
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-6240
Mailing Address - Country:US
Mailing Address - Phone:402-764-2491
Mailing Address - Fax:402-764-4033
Practice Address - Street 1:1356 - 126TH ROAD
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-6240
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:402-764-4033
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE32368OtherBCBS
NE47071134100Medicaid
NE1083616502Medicaid
NE1083616502Medicaid
NE096769Medicare PIN
NENA1613005Medicare PIN