Provider Demographics
NPI:1134786064
Name:BUDDIE-DAMON, DEREK JAGGER
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JAGGER
Last Name:BUDDIE-DAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0210
Mailing Address - Country:US
Mailing Address - Phone:406-210-4643
Mailing Address - Fax:406-204-3238
Practice Address - Street 1:54699 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-8915
Practice Address - Country:US
Practice Address - Phone:406-274-0845
Practice Address - Fax:406-204-3238
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst