Provider Demographics
NPI:1922260280
Name:HARRISON, JAMIE DOST (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DOST
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:SUE
Other - Last Name:DOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:817 S MOUNT AUBURN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6383
Mailing Address - Country:US
Mailing Address - Phone:573-519-4500
Mailing Address - Fax:573-519-4530
Practice Address - Street 1:817 S MOUNT AUBURN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6383
Practice Address - Country:US
Practice Address - Phone:573-519-4500
Practice Address - Fax:573-519-4530
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008015975207Q00000X
MO2011002805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine