Healthcare Provider Details

I. General information

NPI: 1235228644
Provider Name (Legal Business Name): ERIC S. CAMERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

6340 SW 5TH COURT
PLANTATION FL
33317-3908
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2020
  • Fax: 954-985-1434
Mailing address:
  • Phone: 954-987-2020
  • Fax: 954-985-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0055679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: