Provider Demographics
NPI:1255915815
Name:MINCER, DAMEON EUGENE
Entity type:Individual
Prefix:
First Name:DAMEON
Middle Name:EUGENE
Last Name:MINCER
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 23532
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3532
Mailing Address - Country:US
Mailing Address - Phone:803-497-2068
Mailing Address - Fax:
Practice Address - Street 1:7602 HUNT CLUB RD APT D107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-2424
Practice Address - Country:US
Practice Address - Phone:803-497-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date: