Healthcare Provider Details

I. General information

NPI: 1790747889
Provider Name (Legal Business Name): CAMERON ALEXANDER GILLESPIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DOCTORS PARK
GALAX VA
24333-2276
US

IV. Provider business mailing address

PO BOX 1337
GALAX VA
24333-1337
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-5161
  • Fax:
Mailing address:
  • Phone: 276-236-3210
  • Fax: 276-236-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberPT22030
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number010-1026376
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number010-1026376
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number010-1026376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: