Provider Demographics
NPI:1902888514
Name:DAMUTH, HAROLD D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:D
Last Name:DAMUTH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:808 PENINSULA AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1447
Mailing Address - Country:US
Mailing Address - Phone:909-630-7480
Mailing Address - Fax:909-397-0194
Practice Address - Street 1:1798 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-630-7480
Practice Address - Fax:909-630-7480
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG400722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F10859Medicare UPIN