Healthcare Provider Details

I. General information

NPI: 1982395661
Provider Name (Legal Business Name): CAMERON ROBERT DODGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 KISKER RD STE 200
SAINT CHARLES MO
63304-8788
US

IV. Provider business mailing address

610 SW 52ND ST APT 910
LAWTON OK
73505-6854
US

V. Phone/Fax

Practice location:
  • Phone: 636-498-5850
  • Fax: 636-498-5886
Mailing address:
  • Phone: 314-681-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026037548
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: