Provider Demographics
NPI:1508886813
Name:DAMRON, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:DAMRON
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 1:31 EAGLE RDG
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-5907
Mailing Address - Country:US
Mailing Address - Phone:505-470-7000
Mailing Address - Fax:505-986-5048
Practice Address - Street 1:31 EAGLE RDG
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-5907
Practice Address - Country:US
Practice Address - Phone:505-470-7000
Practice Address - Fax:505-986-5048
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75-1312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33266Medicaid
NM33266Medicaid
NMSANFT006Medicare PIN
300022969Medicare PIN