Provider Demographics
NPI:1326073081
Name:DAMSKER, KEITH E (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:E
Last Name:DAMSKER
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 1:110 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1708
Mailing Address - Country:US
Mailing Address - Phone:310-419-3340
Mailing Address - Fax:310-419-3411
Practice Address - Street 1:110 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1708
Practice Address - Country:US
Practice Address - Phone:310-419-3340
Practice Address - Fax:310-419-3411
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429698207R00000X
WAMD60190998207R00000X
CAC54755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38413Medicare UPIN
PA105723Medicare PIN