Provider Demographics
NPI:1164080354
Name:DOUGLAS, CAMERON (DO)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3235
Mailing Address - Country:US
Mailing Address - Phone:603-524-3211
Mailing Address - Fax:603-527-2984
Practice Address - Street 1:80 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3235
Practice Address - Country:US
Practice Address - Phone:603-524-3211
Practice Address - Fax:603-527-2984
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151013718207P00000X
NH24122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine