Provider Demographics
NPI:1952393837
Name:JAMERSON, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:JAMERSON
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 1:757 45TH STREET
Mailing Address - Street 2:STE. 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-922-5550
Mailing Address - Fax:219-922-5555
Practice Address - Street 1:2001 U.S. 41
Practice Address - Street 2:
Practice Address - City:SCHEREVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-365-0970
Practice Address - Fax:219-365-1830
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-01-27
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
IN01039372207Y00000X
IN01039372A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100102610BMedicaid
2051064OtherAETNA US HEALTH SERVICE
5590201001OtherCIGNA
040012827OtherRAILROAD MEDICARE
IL90000851OtherBCBS OF IL
IN000000093105OtherANTHEM BLUE CROSS
352051779001OtherTRICARE
IL90000851OtherBCBS OF IL
5590201001OtherCIGNA