Provider Demographics
NPI:1043391998
Name:RAY H CAMERON MD PHD
Entity Type:Organization
Organization Name:RAY H CAMERON MD PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-779-7080
Mailing Address - Street 1:1711 S STEPHENSON AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3650
Mailing Address - Country:US
Mailing Address - Phone:906-779-7080
Mailing Address - Fax:906-779-7090
Practice Address - Street 1:1711 S STEPHENSON AVE STE 320
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-779-7080
Practice Address - Fax:906-779-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2640367Medicaid
WI21299600Medicaid
MIMI1168Medicare PIN