1073772836 NPI number — DR. MAUREEN VIRGINIA MARTIN JAMIESON DC

Table of content: DR. MAUREEN VIRGINIA MARTIN JAMIESON DC (NPI 1073772836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073772836 NPI number — DR. MAUREEN VIRGINIA MARTIN JAMIESON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN JAMIESON
Provider First Name:
MAUREEN
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073772836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7322 CRAIGSHIRE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-679-9816
Provider Business Mailing Address Fax Number:
214-389-1949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8117 PRESTON RD STE 680
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75225-6326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-679-9816
Provider Business Practice Location Address Fax Number:
214-389-1949
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5984 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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