Provider Demographics
NPI:1962476077
Name:JAMISON, THOMAS SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SCOTT
Last Name:JAMISON
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 1:9160 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1874
Mailing Address - Country:US
Mailing Address - Phone:314-801-8898
Mailing Address - Fax:
Practice Address - Street 1:9160 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1874
Practice Address - Country:US
Practice Address - Phone:314-801-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047305207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C17399Medicare UPIN
VA00X159C01Medicare PIN
P00361714Medicare PIN