Provider Demographics
NPI:1306824578
Name:GODFREY, CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:GODFREY
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 1:1 BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1123
Mailing Address - Country:US
Mailing Address - Phone:940-264-5500
Mailing Address - Fax:940-264-5503
Practice Address - Street 1:1 BURNSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1123
Practice Address - Country:US
Practice Address - Phone:940-264-5500
Practice Address - Fax:940-264-5503
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6674207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1171811-01Medicaid
TXB23025OtherUPIN
TXB23025OtherUPIN
TX1171811-01Medicaid
TX816969Medicare PIN