Healthcare Provider Details

I. General information

NPI: 1720044027
Provider Name (Legal Business Name): JOHN E CAMERON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

IV. Provider business mailing address

13403 BOYETTE RD
RIVERVIEW FL
33569-8742
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-1775
  • Fax: 813-651-9082
Mailing address:
  • Phone: 813-654-1775
  • Fax: 813-651-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA821
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104010
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: