Provider Demographics
NPI:1750383774
Name:JAMIESON, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWARD
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1220 SUNSHINE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4234
Mailing Address - Country:US
Mailing Address - Phone:307-587-5545
Mailing Address - Fax:307-527-5202
Practice Address - Street 1:1220 SUNSHINE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4234
Practice Address - Country:US
Practice Address - Phone:307-587-5545
Practice Address - Fax:307-527-5202
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2009-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY4038A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F14031Medicare UPIN