Provider Demographics
NPI:1326702077
Name:JAMIESON, WILLIAM BLAKE (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAKE
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:401 RACE ST APT 451
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-1032
Mailing Address - Country:US
Mailing Address - Phone:775-842-7289
Mailing Address - Fax:
Practice Address - Street 1:1013 GALLERIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1363
Practice Address - Country:US
Practice Address - Phone:916-918-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant