Provider Demographics
NPI:1609047729
Name:DERMON, JAMIE DUBOIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:DUBOIS
Last Name:DERMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:P.O. BOX 245057
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-0001
Mailing Address - Country:US
Mailing Address - Phone:520-626-7233
Mailing Address - Fax:520-626-1633
Practice Address - Street 1:23625 HOLMAN HWY
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5902
Practice Address - Country:US
Practice Address - Phone:183-162-5531
Practice Address - Fax:831-625-4948
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80898207P00000X
CAA125906207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMAAA1133Medicare PIN