Provider Demographics
NPI:1942597802
Name:JAMISON, ROBERT LAWRENCE (LMP)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:JAMISON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 W HILDEBRAND BLVD
Mailing Address - Street 2:K350
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1975
Mailing Address - Country:US
Mailing Address - Phone:541-292-9044
Mailing Address - Fax:
Practice Address - Street 1:7101 W HOOD PL
Practice Address - Street 2:SUITE A102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6700
Practice Address - Country:US
Practice Address - Phone:509-491-1155
Practice Address - Fax:509-491-1156
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60218587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist