Healthcare Provider Details

I. General information

NPI: 1154640779
Provider Name (Legal Business Name): CAMILLE ALEXIS MCGAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAMILLE BAUGH MD

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GROOVER LOOP STE 200
ST AUGUSTINE FL
32086-6569
US

IV. Provider business mailing address

216 SOUTHPARK CIR E
ST AUGUSTINE FL
32086-5135
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-7205
  • Fax: 904-396-4047
Mailing address:
  • Phone: 904-824-6108
  • Fax: 904-584-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME118985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: