MEDICARE: CAMERON DUVALL

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	208800000X	Urology Physician	1699759563	SC

General Provider Information

NPI Number	:	1205769312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON DUVALL

Provider Business Mailing Address
First Line	:	150 NEWTON RD
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-9349
Country	:	US
Telephone Number	:	801-347-1662
Fax Number	:

Provider Business Practice Location Address
First Line	:	2890 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9171
Country	:	US
Telephone Number	:	843-797-6600
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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1699759563 — DR. THEODORE EDWARD BRISSON M.D.
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Directions to “ CAMERON DUVALL ” Practice Location

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