Healthcare Provider Details

I. General information

NPI: 1144740150
Provider Name (Legal Business Name): CAMERON FREDERICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date: 08/08/2025
Reactivation Date: 08/21/2025

III. Provider practice location address

6801 BRECKSVILLE RD
INDEPENDENCE OH
44131-5032
US

IV. Provider business mailing address

1580 SANTA BARBARA BLVD
THE VILLAGES FL
32159-6827
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-3765
  • Fax:
Mailing address:
  • Phone: 352-259-2159
  • Fax: 352-259-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME141736
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35.151479
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: