Provider Demographics
NPI:1225670862
Name:COLE, CAMERIN J
Entity Type:Individual
Prefix:
First Name:CAMERIN
Middle Name:J
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 HAVERWOOD LN APT 112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4206
Mailing Address - Country:US
Mailing Address - Phone:972-890-6557
Mailing Address - Fax:
Practice Address - Street 1:4701 HAVERWOOD LN APT 112
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4206
Practice Address - Country:US
Practice Address - Phone:972-890-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty