Provider Demographics
NPI:1427148352
Name:HILL, DAMON HERBIE (MD)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:HERBIE
Last Name:HILL
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 1:3516 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1316
Mailing Address - Country:US
Mailing Address - Phone:806-797-3322
Mailing Address - Fax:806-797-6633
Practice Address - Street 1:3516 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1316
Practice Address - Country:US
Practice Address - Phone:806-797-3322
Practice Address - Fax:806-797-6633
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8P1100OtherBLUE CROSS/BLUESHIELD
NM000W5748Medicaid
TX139194816Medicaid
201237576OtherTAX ID
8P1100OtherBLUE CROSS/BLUESHIELD
NM000W5748Medicaid