Healthcare Provider Details

I. General information

NPI: 1982215471
Provider Name (Legal Business Name): ACEL BLAKE CAMFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY DEPT
O FALLON MO
63368-2206
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-5145
  • Fax: 314-878-7678
Mailing address:
  • Phone: 314-514-3500
  • Fax: 314-848-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007373
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: