Provider Demographics
NPI:1700863404
Name:DAMERON, JASON R (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:DAMERON
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 1:1205 OAKHAVEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550
Mailing Address - Country:US
Mailing Address - Phone:843-332-1716
Mailing Address - Fax:843-332-1091
Practice Address - Street 1:704 MEDICAL PARK DRIVE
Practice Address - Street 2:HARTSVILLE SURGICAL CENTER LLP
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550
Practice Address - Country:US
Practice Address - Phone:843-332-1099
Practice Address - Fax:843-332-1091
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25489208600000X
NC200500562208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2042637Medicare ID - Type Unspecified
I34740Medicare UPIN
SCI347405156Medicare PIN