Provider Demographics
NPI:1023038916
Name:CLEMENT, CAMERON DARIUS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:DARIUS
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21327 LA PENA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2939
Mailing Address - Country:US
Mailing Address - Phone:509-590-8908
Mailing Address - Fax:
Practice Address - Street 1:3880 ROGER BROOKE DR.
Practice Address - Street 2:C/O GENERAL SURGERY DEPT/SAMMC
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-8548
Practice Address - Country:US
Practice Address - Phone:509-590-8908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1050306OtherNCCPA CERTIFICATION