Provider Demographics
NPI:1114120250
Name:CAMERON INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:CAMERON INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:BYROM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-632-2801
Mailing Address - Street 1:323 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-1748
Mailing Address - Country:US
Mailing Address - Phone:816-632-2801
Mailing Address - Fax:816-632-7091
Practice Address - Street 1:323 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:MO
Practice Address - Zip Code:64429-1748
Practice Address - Country:US
Practice Address - Phone:816-632-2801
Practice Address - Fax:816-632-7091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5P67207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT863695Medicare ID - Type Unspecified