Provider Demographics
NPI:1730491556
Name:DARSEY, DAMON ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAMON
Middle Name:ALLEN
Last Name:DARSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5570
Mailing Address - Fax:601-984-5583
Practice Address - Street 1:2500 NORTH STATE ST.
Practice Address - Street 2:DEPT. OF EMERGENCY MEDICINE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-984-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-2303207P00000X
MS21813207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL170884Medicaid
MS04756525Medicaid
LA2406426Medicaid
MS04756525Medicaid
MS255774YWZ1Medicare PIN
MS355774YJ5DMedicare PIN