Provider Demographics
NPI:1376805069
Name:JAMESON, BRIAN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARD
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 1:4409 TWISTED TREE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6431
Mailing Address - Country:US
Mailing Address - Phone:215-684-9981
Mailing Address - Fax:
Practice Address - Street 1:4409 TWISTED TREE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6431
Practice Address - Country:US
Practice Address - Phone:215-684-9981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6801207Q00000X
TXB0099522973207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty