Provider Demographics
NPI:1396712063
Name:JAMISON-BLAIR, DIANE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELIZABETH
Last Name:JAMISON-BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:STE 4007
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-3821
Mailing Address - Fax:318-212-3825
Practice Address - Street 1:8001 YOUREE DR STE 4007
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-3821
Practice Address - Fax:318-212-3825
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6076207R00000X, 208M00000X
LAMD.021974208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00005091OtherRR MEDICARE
TX157381801Medicaid
TX157381801Medicaid
TX8A5741Medicare PIN