Basic Information
| Provider Information | |||||||||
| NPI: | 1952393837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMERSON | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 757 45TH STREET | ||||||||
| Address2: | STE. 201 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199225550 | ||||||||
| FaxNumber: | 2199225555 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 U.S. 41 | ||||||||
| Address2: | |||||||||
| City: | SCHEREVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193650970 | ||||||||
| FaxNumber: | 2193651830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 01/27/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/23/2006 | ||||||||
| NPIReactivationDate: | 03/28/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 01039372 | IN | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 01039372A | IN | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 100102610B | 05 | IN | MEDICAID | 2051064 | 01 | AETNA US HEALTH SERVICE | OTHER | 5590201001 | 01 | CIGNA | OTHER | 040012827 | 01 | RAILROAD MEDICARE | OTHER | 90000851 | 01 | IL | BCBS OF IL | OTHER | 000000093105 | 01 | IN | ANTHEM BLUE CROSS | OTHER | 352051779001 | 01 | TRICARE | OTHER |