Provider Demographics
NPI:1093821274
Name:DAMIANI, JOSEPH M (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:DAMIANI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2407 W LOUISIANA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5807
Mailing Address - Country:US
Mailing Address - Phone:432-687-5000
Mailing Address - Fax:432-687-5001
Practice Address - Street 1:2407 W LOUISIANA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5807
Practice Address - Country:US
Practice Address - Phone:432-687-5000
Practice Address - Fax:432-687-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7634208200000X, 2082S0105X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033555602Medicaid
TX033555602Medicaid