Provider Demographics
NPI:1114920246
Name:JAMESON, WILLIAM DEAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
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 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE STE 200
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-641-3000
Practice Address - Fax:901-701-2400
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20296207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051593Medicaid
TN620819926OtherAETNA
MS007238527Medicaid
TN3037120OtherBCBS
TN2675407OtherCIGNA
TN620819926OtherTRICARE
AR110318002Medicaid
TN4110755OtherAETNA
AR117286001Medicaid
TN3371161Medicaid
TN200022156OtherRAILROAD MEDICARE
TN00000001062OtherTLC
MS620819926OtherBCBS
TN620819926OtherCIGNA
MS7187860Medicaid
TN620819926OtherCIGNA
AR117286001Medicaid
MS620819926OtherBCBS