Provider Demographics
NPI:1104941855
Name:JAMESON, FLORENCE (MD)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:JAMESON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5281 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2311
Mailing Address - Country:US
Mailing Address - Phone:702-262-9676
Mailing Address - Fax:702-262-9707
Practice Address - Street 1:5281 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2311
Practice Address - Country:US
Practice Address - Phone:702-262-9676
Practice Address - Fax:702-262-9707
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5203OtherNV STATE LICENSE
NV002002762Medicaid
NVD35456Medicare UPIN
NV002002762Medicaid