Provider Demographics
NPI:1316006166
Name:CAMERON, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:CAMERON
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 1:3449 NORTH ANCHOR SUITE 300A
Mailing Address - Street 2:CONCENTRA
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-7808
Mailing Address - Country:US
Mailing Address - Phone:907-903-9212
Mailing Address - Fax:907-796-8455
Practice Address - Street 1:3449 N ANCHOR ST
Practice Address - Street 2:SUITE 300A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-7679
Practice Address - Country:US
Practice Address - Phone:907-903-9212
Practice Address - Fax:907-796-8455
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5241207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD40901Medicaid