Provider Demographics
NPI:1639249782
Name:DAMERON, LAYNE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAYNE
Middle Name:A
Last Name:DAMERON
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 1:2321 PYRAMID WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431
Mailing Address - Country:US
Mailing Address - Phone:775-331-1919
Mailing Address - Fax:775-331-2008
Practice Address - Street 1:2321 PYRAMID WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431
Practice Address - Country:US
Practice Address - Phone:775-331-1919
Practice Address - Fax:775-331-2008
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10197768-0501213E00000X
AZPOD000886213ES0103X
NV2061213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT190753OtherPEHP
UT1639249782OtherDMBA
UT190753OtherPEHP
114136Medicare PIN