Provider Demographics
NPI:1003960097
Name:BLAIR, DAMION S (LMT)
Entity Type:Individual
Prefix:
First Name:DAMION
Middle Name:S
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 SE UGLOW AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2648
Mailing Address - Country:US
Mailing Address - Phone:503-385-6018
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:SUITE 120
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:503-385-6018
Practice Address - Fax:503-586-0255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist