Provider Demographics
NPI:1154640779
Name:MCGAW, CAMILLE ALEXIS (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ALEXIS
Last Name:MCGAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:BAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:216 SOUTHPARK CIR E
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5135
Mailing Address - Country:US
Mailing Address - Phone:904-824-6108
Mailing Address - Fax:904-584-1000
Practice Address - Street 1:216 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5135
Practice Address - Country:US
Practice Address - Phone:904-824-6108
Practice Address - Fax:904-584-1000
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME118985207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011676400Medicaid
FL011676400Medicaid