Provider Demographics
NPI:1376662080
Name:CAMERON, DENTON JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:DENTON
Middle Name:JACKSON
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 1:491 E 3125 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4225
Mailing Address - Country:US
Mailing Address - Phone:801-377-0726
Mailing Address - Fax:
Practice Address - Street 1:491 E 3125 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4225
Practice Address - Country:US
Practice Address - Phone:801-377-0726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT160231-1205146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant