Healthcare Provider Details

I. General information

NPI: 1225176191
Provider Name (Legal Business Name): DAMON BRICE ARMITAGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MELTON RD
CRESWELL OR
97426-9453
US

IV. Provider business mailing address

PO BOX 1060
CRESWELL OR
97426-1060
US

V. Phone/Fax

Practice location:
  • Phone: 541-658-5301
  • Fax: 541-658-5304
Mailing address:
  • Phone: 541-658-5301
  • Fax: 541-658-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2008-0576
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberMD2008-0576
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27022
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: