Healthcare Provider Details

I. General information

NPI: 1336821206
Provider Name (Legal Business Name): CAMERON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S MAIN ST
JACKSONVILLE TX
75766-4927
US

IV. Provider business mailing address

417 S MAIN ST
JACKSONVILLE TX
75766-4927
US

V. Phone/Fax

Practice location:
  • Phone: 903-284-5442
  • Fax:
Mailing address:
  • Phone: 903-284-5442
  • Fax: 430-242-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES CAMERON
Title or Position: OWNER
Credential: MD
Phone: 903-284-5442