Provider Demographics
NPI:1053879346
Name:JAMIESON, STEVE THEODORE
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:THEODORE
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 W ROLLINS RD APT C12
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-0769
Mailing Address - Country:US
Mailing Address - Phone:314-610-8122
Mailing Address - Fax:
Practice Address - Street 1:6220 ITASKA ST # C12
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-3140
Practice Address - Country:US
Practice Address - Phone:314-610-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program