Provider Demographics
NPI:1548392871
Name:JAMISON, MICHAEL THURMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THURMAN
Last Name:JAMISON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2893 W NEMI LN
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-1337
Mailing Address - Country:US
Mailing Address - Phone:805-640-7482
Mailing Address - Fax:805-288-0060
Practice Address - Street 1:3901 LAS POSAS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1501
Practice Address - Country:US
Practice Address - Phone:805-388-0080
Practice Address - Fax:805-388-0060
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55012207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770541431OtherSTATE TAX ID
CAG55012OtherSTATE LICENSE NUMBER
CAG55012OtherSTATE LICENSE NUMBER
CAE82302Medicare UPIN