Provider Demographics
NPI:1083717615
Name:DAMERON, ZECHARIAH CLIFTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:ZECHARIAH
Middle Name:CLIFTON
Last Name:DAMERON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ZECH
Other - Middle Name:C
Other - Last Name:DAMERON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8 MEDICAL PARKWAY
Mailing Address - Street 2:#208
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7842
Mailing Address - Country:US
Mailing Address - Phone:972-247-5466
Mailing Address - Fax:972-247-6525
Practice Address - Street 1:8 MEDICAL PARKWAY
Practice Address - Street 2:#208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7842
Practice Address - Country:US
Practice Address - Phone:972-247-5466
Practice Address - Fax:972-247-6525
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C14993Medicare UPIN
00B19LMedicare ID - Type Unspecified