Basic Information
| Provider Information | |||||||||
| NPI: | 1780070938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAMRON | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LUKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 10TH AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918714 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 MEDICAL CENTER DR STE 3500 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911374 | ||||||||
| FaxNumber: | 3046911375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 30390 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.