Provider Demographics
NPI:1689069296
Name:DEMARIS, DARRYL GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:GEORGE
Last Name:DEMARIS
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 1:2020 COURT ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1822
Mailing Address - Country:US
Mailing Address - Phone:530-243-1249
Mailing Address - Fax:
Practice Address - Street 1:2020 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-243-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3026292083A0100X, 2085R0202X, 2085R0204X, 208D00000X
CAA1722772085R0202X, 2085R0204X
TXBP100575912085R0202X
NMNOTYETAVAILABLE2085R0204X
LAPGY.202841208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice