Individual
WALLACE GLENN JAMISON
Active
Individual
WALLACE GLENN JAMISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
—
P010234609
BLUE CHOICE
NY
01
—
P020234609
ROCHESTER BLUE SHIELD
—
01
—
RA6483
RAILROAD MEDICARE
NY
Enumeration date
07/31/2006
Last updated
03/22/2023
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