Provider Demographics
NPI:1629075288
Name:DAUPHINEE, DAMIEN M (DPM)
Entity Type:Individual
Prefix:
First Name:DAMIEN
Middle Name:M
Last Name:DAUPHINEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 UNICORN LAKE BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0121
Mailing Address - Country:US
Mailing Address - Phone:866-490-3668
Mailing Address - Fax:940-243-7780
Practice Address - Street 1:3319 UNICORN LAKE BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0121
Practice Address - Country:US
Practice Address - Phone:866-490-3668
Practice Address - Fax:940-243-7780
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1429213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
8AD030OtherBLUE CROSS/BLUE SHIELD
TX1429OtherSTATE LICENSE
TXU72979Medicare UPIN