MEDICARE: CAMERON GOSNELL

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902740830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON GOSNELL

Provider Business Mailing Address
First Line	:	3445 HAYNIE AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-1842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9301 N CENTRAL EXPY STE 400-500
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0806
Country	:	US
Telephone Number	:	214-220-2468
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ CAMERON GOSNELL ” Practice Location

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