Provider Demographics
NPI:1235714387
Name:DAMERON, BRUCE EDWARD
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWARD
Last Name:DAMERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 E MOUND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-1226
Mailing Address - Country:US
Mailing Address - Phone:740-577-3834
Mailing Address - Fax:
Practice Address - Street 1:84 E MOUND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-1226
Practice Address - Country:US
Practice Address - Phone:740-577-3834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator