Healthcare Provider Details

I. General information

NPI: 1366422644
Provider Name (Legal Business Name): ROBERT WILLIAM CAMERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 BOGLE ST SUITE B
SOMERSET KY
42503-2895
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 202
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-9448
  • Fax: 606-451-9450
Mailing address:
  • Phone: 859-971-4685
  • Fax: 859-971-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37884
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number37884
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: