Individual
DR. DAMASUS S. JAYAMANNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 761-4351
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-5264
(573) 761-4351
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R1J19
MO
207RP1001X
Pulmonary Disease Physician
Primary
R1J19
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110042202
MEDICARE RAILROAD
MO
01
—
11650
BCBS
MO
01
—
189447
HEALTHLINK
—
05
—
202560215
—
MO
01
—
CC7852
RR GROUP
MO
Enumeration date
12/20/2005
Last updated
07/31/2008
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