Provider Demographics
NPI:1417018656
Name:CAMERON, ALAN BART SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BART
Last Name:CAMERON
Suffix:SR
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 1:5012 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-2902
Mailing Address - Country:US
Mailing Address - Phone:612-920-0365
Mailing Address - Fax:
Practice Address - Street 1:5012 4TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-2902
Practice Address - Country:US
Practice Address - Phone:612-920-0365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19254OtherLICENSE
IA017204OtherLICENSE