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General NPI Number Information
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NPI Number | 1154640779
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Entity Type | Individual
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Provider Name | CAMILLE ALEXIS MCGAW M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 40 GROOVER LOOP STE 200
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-6569
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Country | US
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Telephone | 904-398-7205
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Fax | 904-396-4047
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Provider Business Mailing Address
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Address Line | 216 SOUTHPARK CIR E
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5135
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Country | US
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Telephone | 904-824-6108
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Fax | 904-584-1000
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME118985
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License Number State | FL
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