Provider Demographics
NPI:1528508520
Name:BROWN, DAMONE (CRM)
Entity type:Individual
Prefix:MR
First Name:DAMONE
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:DAMON
Other - Middle Name:BATEASE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRM
Mailing Address - Street 1:PO BOX 16756
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0756
Mailing Address - Country:US
Mailing Address - Phone:503-560-1654
Mailing Address - Fax:
Practice Address - Street 1:10209 SE WASHINGTON ST
Practice Address - Street 2:SUITE D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216
Practice Address - Country:US
Practice Address - Phone:503-560-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-CRM-172175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist