Healthcare Provider Details

I. General information

NPI: 1316006166
Provider Name (Legal Business Name): STEPHEN CAMERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3449 N ANCHOR ST SUITE 300A
PORTLAND OR
97217-7679
US

IV. Provider business mailing address

3449 NORTH ANCHOR SUITE 300A CONCENTRA
PORTLAND OR
97217-7808
US

V. Phone/Fax

Practice location:
  • Phone: 907-903-9212
  • Fax: 907-796-8455
Mailing address:
  • Phone: 907-903-9212
  • Fax: 907-796-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5241
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: