Provider Demographics
NPI:1033544325
Name:DAMERON MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:DAMERON MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-461-3100
Mailing Address - Street 1:420 W ACACIA ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2441
Mailing Address - Country:US
Mailing Address - Phone:209-461-3196
Mailing Address - Fax:209-461-7593
Practice Address - Street 1:530 W ACACIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2454
Practice Address - Country:US
Practice Address - Phone:209-461-3196
Practice Address - Fax:209-461-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty