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NPI Code Detail

MEDICARE: DR. CAMERON DOUGLAS GIFFORD MD

MEDICARE: DR. CAMERON DOUGLAS GIFFORD MD
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
1207R00000XInternal Medicine Physician01048NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00444621OTHERNCRAILROAD MEDICARE
3801561OTHERNCBLUE MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2129M5OTHERNCBLUECROSS BLUESHIELD
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396740874
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMERON DOUGLAS GIFFORD MD
Provider Business Mailing Address
First Line : PO BOX 1329
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47402-1329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 601 W 2ND ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2317
Country : US
Telephone Number : 812-676-4542
Fax Number : 812-353-3713
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2005
Last Update Date : 01/27/2021

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