Provider Demographics
NPI:1790949352
Name:BLUEITT, DAMOND (MD)
Entity Type:Individual
Prefix:
First Name:DAMOND
Middle Name:
Last Name:BLUEITT
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 1:8210 WALNUT HILL LN STE 130
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4418
Mailing Address - Country:US
Mailing Address - Phone:214-750-1207
Mailing Address - Fax:217-750-8504
Practice Address - Street 1:5900 ALTAMESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-5473
Practice Address - Country:US
Practice Address - Phone:817-854-9969
Practice Address - Fax:817-854-9965
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2407207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203781402Medicaid
TX203781401Medicaid
TX203781402Medicaid
TX8L16617Medicare PIN