Healthcare Provider Details

I. General information

NPI: 1275194664
Provider Name (Legal Business Name): CAMERON L STUMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

IV. Provider business mailing address

7575 5 MILE RD
CINCINNATI OH
45230-4346
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-7100
  • Fax: 513-624-1240
Mailing address:
  • Phone: 513-232-7100
  • Fax: 513-624-1240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351045474
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.146406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: