Provider Demographics
NPI:1396785317
Name:DAMRON, DOUGLAS LEN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LEN
Last Name:DAMRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-1132
Mailing Address - Country:US
Mailing Address - Phone:865-898-0376
Mailing Address - Fax:
Practice Address - Street 1:110 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5281
Practice Address - Country:US
Practice Address - Phone:865-471-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4154001OtherBLUE CROSS
TNP00233170OtherRAILROAD
TN3859555Medicaid
TN4065461OtherBLUE CROSS
TN3859554Medicaid
TN4065461OtherBLUE CROSS
TN3859554Medicaid