Provider Demographics
NPI:1760602361
Name:RONALD E. JAMERSON, M.D.,P.C.
Entity Type:Organization
Organization Name:RONALD E. JAMERSON, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:JAMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-322-7462
Mailing Address - Street 1:24 JOLIET ST
Mailing Address - Street 2:SUTIE 301
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1705
Mailing Address - Country:US
Mailing Address - Phone:219-322-7462
Mailing Address - Fax:219-322-8347
Practice Address - Street 1:24 JOLIET ST
Practice Address - Street 2:SUTIE 301
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1705
Practice Address - Country:US
Practice Address - Phone:219-322-7462
Practice Address - Fax:219-322-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039372207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND84453Medicare UPIN
IN083750Medicare ID - Type Unspecified