MEDICARE: IAN JAMESON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1891047130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN JAMESON

Provider Business Mailing Address
First Line	:	2508 PACIFIC AVE
Second Line	:	APT. #2
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2377
Country	:	US
Telephone Number	:	208-351-7245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2508 PACIFIC AVE
Second Line	:	APT. #2
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2377
Country	:	US
Telephone Number	:	208-351-7245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2012
Last Update Date	:	10/10/2012

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Directions to “ IAN JAMESON ” Practice Location

Language	Start Address	Practice Location

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