Provider Demographics
NPI:1376107060
Name:LANCARTE, CAMERON PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:PAUL
Last Name:LANCARTE
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 1:1020 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3920
Mailing Address - Country:US
Mailing Address - Phone:580-223-5311
Mailing Address - Fax:580-223-2397
Practice Address - Street 1:1020 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3920
Practice Address - Country:US
Practice Address - Phone:580-223-5311
Practice Address - Fax:580-223-2397
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41187207Q00000X
TXBP10071193390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10071193OtherPIT LICENSE