| Doctor Name: | JAMISON DEREK FERAMISCO |
| NPI Number: | 1043410871 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD PHD |
| License Number: | A105161 |
| Business Practice Address: | 1125 Sir Francis Drake Blvd Kentfield, CA - 949041418 |
| Business Phone Number: | 4154569680 |
| Business Fax Number: | 4154853622 |
| Mailing Address: | 31566 Railroad Canyon Road, 2-130 CANYON LAKE |
| State: | CA |
| Postal Code: | 925879446 |
| Phone Number: | 8778709301 |
| Fax Number: | 8778820462 |
| NPI Enumeration Date: | 07/19/2007 |
| NPI Last Update Date: | 08/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A105161 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |