Provider Demographics
NPI:1558345801
Name:JAMESON, BRETTON H (MD)
Entity Type:Individual
Prefix:
First Name:BRETTON
Middle Name:H
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 1:511 S WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-6962
Mailing Address - Country:US
Mailing Address - Phone:405-707-0900
Mailing Address - Fax:405-707-3363
Practice Address - Street 1:511 S WINDSOR DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-6962
Practice Address - Country:US
Practice Address - Phone:405-707-0900
Practice Address - Fax:405-707-3363
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21241207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200004910BMedicaid
243716304Medicare PIN
H79518Medicare UPIN