Individual
DR. THERON QUENTIN JAMESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
550 REDSTONE AVE W STE 370, CRESTVIEW, FL 32536-6429
(850) 306-2710
Mailing address
PO BOX 540, WEST BURLINGTON, IA 52655
(319) 768-4970
(319) 768-4975
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
03133
IA
207X00000X
Orthopaedic Surgery Physician
03133
IA
207X00000X
Orthopaedic Surgery Physician
Primary
OS19000
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932101466
—
IA
01
—
P00688747
RR MEDICARE
IA
Enumeration date
08/15/2005
Last updated
03/17/2024
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