Provider Demographics
NPI:1255329520
Name:DAMOURS, RAY H (MD)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:H
Last Name:DAMOURS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 AUTO CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-267-6876
Mailing Address - Fax:661-538-9438
Practice Address - Street 1:819 AUTO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-267-6876
Practice Address - Fax:661-538-9438
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86236174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86236AMedicare ID - Type Unspecified
F48360Medicare UPIN