Healthcare Provider Details

I. General information

NPI: 1366801805
Provider Name (Legal Business Name): CAMERON SHUMWAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR
COEUR D ALENE ID
83814-2656
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 130
COEUR D ALENE ID
83814-4404
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4700
  • Fax:
Mailing address:
  • Phone: 801-592-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberO-1676
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberO-1676
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: