Provider Demographics
NPI:1811035314
Name:DAMEFF, EMIL A (MD)
Entity Type:Individual
Prefix:
First Name:EMIL
Middle Name:A
Last Name:DAMEFF
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 1:3162 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33982-3316
Mailing Address - Country:US
Mailing Address - Phone:941-380-6022
Mailing Address - Fax:941-575-1964
Practice Address - Street 1:3162 WILLOW RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-3316
Practice Address - Country:US
Practice Address - Phone:941-380-6022
Practice Address - Fax:941-575-1964
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63276207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258250300Medicaid
H06525Medicare UPIN
FL49307YMedicare PIN
FL49307AMedicare ID - Type Unspecified