Provider Demographics
NPI:1154324176
Name:DAMRON, RICK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:ALLEN
Last Name:DAMRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Mailing Address - Street 2:STE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8419
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-942-7331
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD STE 200
Practice Address - Street 2:STE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8419
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-942-7331
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME42103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99039OtherGROUP BCBS NUMBER
FL067813900Medicaid
FL37450OtherINDIVIDUAL BCBS ID
GA000307381BMedicaid
FLAJ564OtherMEDICARE GIN
FLP00625819OtherMEDICARE RAIL ROAD
FL99039OtherGROUP BCBS NUMBER
FLD54627Medicare UPIN
FLD54627Medicare UPIN