Healthcare Provider Details

I. General information

NPI: 1538627005
Provider Name (Legal Business Name): CAMERON JOHN ELWARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S ALAMO AVE # 400
DAVIS MONTHAN AFB AZ
85707-4402
US

IV. Provider business mailing address

3280 MITCHELL BLVD
MOODY AFB GA
31699-1500
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2778
  • Fax:
Mailing address:
  • Phone: 229-257-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number91883
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number91883
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: