Provider Demographics
NPI:1376971655
Name:JAMIESON GLENN, MD, INC.
Entity Type:Organization
Organization Name:JAMIESON GLENN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIESON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-230-5188
Mailing Address - Street 1:PO BOX 85466
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92186-5466
Mailing Address - Country:US
Mailing Address - Phone:760-230-5188
Mailing Address - Fax:760-230-5203
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5140
Practice Address - Country:US
Practice Address - Phone:760-230-5188
Practice Address - Fax:760-230-5203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89805207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty