Individual
LEAH BRYANT JAMISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 751-2649
(765) 281-6671
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01036948A
IN
207LP3000X
Pediatric Anesthesiology Physician
01036948A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100118800
—
IN
01
—
224040194
MEDICARE PTAN
IN
Enumeration date
11/15/2005
Last updated
06/08/2023
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