Provider Demographics
NPI:1043950058
Name:ETEBARI, CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:ETEBARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 DOYLE AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3354
Mailing Address - Country:US
Mailing Address - Phone:480-570-9450
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMBRIDGE ST.
Practice Address - Street 2:MAIL STOP 3015
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8501
Practice Address - Country:US
Practice Address - Phone:913-588-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program