Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 234645 | MA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 02003145A | IN |
NPI | 1407028392 |
---|---|
Provider Name | Brent M Damer |
First Address | Muncie, IN 47304-5407 |
Second Address | Muncie, IN 47304-5407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2008 |
Last Update Date | 22/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000610867 | ANTHEM (01) | IN |
200936870 | (05) | IN |