Provider Demographics
NPI:1083808513
Name:ALEXANDER, JAMISON CONRAD (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMISON
Middle Name:CONRAD
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1993
Mailing Address - Street 2:
Mailing Address - City:POTTSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:75076-1993
Mailing Address - Country:US
Mailing Address - Phone:903-416-3650
Mailing Address - Fax:903-416-3651
Practice Address - Street 1:2600 N SAM RAYBURN FWY STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-0500
Practice Address - Country:US
Practice Address - Phone:903-416-3650
Practice Address - Fax:903-416-3651
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4719207V00000X
TXN7202207V00000X, 2083P0011X, 208D00000X
TX47192083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280860202Medicaid
TX280860205Medicaid
OK200180930AMedicaid
TX280860201Medicaid
OKOK402968Medicare Oscar/Certification