MEDICARE: MR. CAMERON DARIUS CLEMENT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1050306	OTHER		NCCPA CERTIFICATION

General Provider Information

NPI Number	:	1023038916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CAMERON DARIUS CLEMENT PA-C

Provider Business Mailing Address
First Line	:	21327 LA PENA DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2939
Country	:	US
Telephone Number	:	509-590-8908
Fax Number	:

Provider Business Practice Location Address
First Line	:	3880 ROGER BROOKE DR.
Second Line	:	C/O GENERAL SURGERY DEPT/SAMMC
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-8548
Country	:	US
Telephone Number	:	509-590-8908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/01/2021

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