Healthcare Provider Details

I. General information

NPI: 1952393837
Provider Name (Legal Business Name): RONALD E JAMERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date: 03/23/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

2001 U.S. 41
SCHEREVILLE IN
46375
US

IV. Provider business mailing address

757 45TH STREET STE. 201
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-0970
  • Fax: 219-365-1830
Mailing address:
  • Phone: 219-922-5550
  • Fax: 219-922-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01039372
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01039372A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: