Healthcare Provider Details

I. General information

NPI: 1083808513
Provider Name (Legal Business Name): JAMISON CONRAD ALEXANDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 05/02/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N HWY 75 STE 130
SHERMAN TX
75090-0500
US

IV. Provider business mailing address

PO BOX 1993
POTTSBORO TX
75076-1993
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-8222
  • Fax: 866-493-4004
Mailing address:
  • Phone: 903-892-8222
  • Fax: 866-493-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4719
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN7202
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number4719
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberN7202
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberN7202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: