Provider Demographics
NPI:1306895347
Name:JAMESON, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:JAMESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8600 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-4612
Mailing Address - Country:US
Mailing Address - Phone:817-265-9700
Mailing Address - Fax:817-277-4164
Practice Address - Street 1:1132 S BOWEN RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2204
Practice Address - Country:US
Practice Address - Phone:817-265-9700
Practice Address - Fax:817-277-4164
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXHO492207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89K852OtherBLUE CROSS BLUE SHIELD
007OtherTRICARE
390001182OtherRAILROAD MEDICARE
TX047890101Medicaid