Healthcare Provider Details

I. General information

NPI: 1508886813
Provider Name (Legal Business Name): JAMES ROBERT DAMRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 EAGLE RDG
SANTA FE NM
87508-5907
US

IV. Provider business mailing address

31 EAGLE RDG
SANTA FE NM
87508-5907
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-7000
  • Fax: 505-986-5048
Mailing address:
  • Phone: 505-470-7000
  • Fax: 505-986-5048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number75-131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: