Provider Demographics
NPI:1699779207
Name:DAMERON, JEFFREY C (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:DAMERON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11137
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1137
Mailing Address - Country:US
Mailing Address - Phone:304-344-3457
Mailing Address - Fax:304-344-3480
Practice Address - Street 1:1538 KANAWHA BLVD E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-2435
Practice Address - Country:US
Practice Address - Phone:304-344-5018
Practice Address - Fax:304-344-3480
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV191302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG87757OtherBRICKSTREET INSURANCE
WV0048356000Medicaid
WV020011800OtherFEDERAL BLACK LUNG
KY64028608Medicaid
WV151237200OtherUS DOL & US POSTAL COMP
OH2138387Medicaid
WV550516458OtherACORDIA NATIONAL PEIA
WV0130753OtherUMWA
WV14175Medicaid
WV55-0516458OtherGROUP FEIN #
WV550516458Medicaid
WV001718806OtherFREEDOM BLUE & MS BCBS
WV14193OtherCARELINK & CARELINK PEIA