Provider Demographics
NPI:1750769360
Name:JAMESON, BRENT (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
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 1:2500 BELLEVUE MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1591
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1356 126TH RD
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine