Individual
WALLACE GLENN JAMISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3285 122ND AVE, ALLEGAN, MI 49010-9511
(269) 673-6617
Mailing address
29 NORTHWEST BLVD, NASHUA, NH 03063-4068
(603) 577-5721
(603) 577-5713
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
234609
NY
2084P0800X
Psychiatry Physician
Primary
4301508760
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02643823
—
NY
01
—
168245EU
PREFERRED CARE
NY
01
—
168245EU
PREFERRED CARE
—
01
—
P010234609
BLUE CHOICE
NY
01
—
P010234609
BLUE CHOICE
—
01
—
P020234609
ROCHESTER BLUE SHIELD
—
01
—
RA6483
RAILROAD MEDICARE
NY
Enumeration date
07/31/2006
Last updated
03/22/2023
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