MEDICARE: CAMERON GORDON HAMPTON SMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD60631260	WA

General Provider Information

NPI Number	:	1144275272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON GORDON HAMPTON SMITH M.D.

Provider Business Mailing Address
First Line	:	263 FARMINGTON AVE
Second Line	:	PRIMARY CARE INTERNAL MEDICINE RESIDENCY L2104
City	:	FARMINGTON
State	:	CT
Zip	:	06030-1234
Country	:	US
Telephone Number	:	860-679-4017
Fax Number	:	860-679-1621

Provider Business Practice Location Address
First Line	:	16045 1ST AVE S FL 1
Second Line	:
City	:	BURIEN
State	:	WA
Zip	:	98148-1401
Country	:	US
Telephone Number	:	206-965-4100
Fax Number	:	206-965-4119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/14/2018

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