Healthcare Provider Details

I. General information

NPI: 1700863404
Provider Name (Legal Business Name): JASON R DAMERON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MEDICAL PARK DRIVE HARTSVILLE SURGICAL CENTER LLP
HARTSVILLE SC
29550
US

IV. Provider business mailing address

1205 OAKHAVEN CIRCLE
HARTSVILLE SC
29550
US

V. Phone/Fax

Practice location:
  • Phone: 843-332-1099
  • Fax: 843-332-1091
Mailing address:
  • Phone: 843-332-1716
  • Fax: 843-332-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25489
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number200500562
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: