Provider Demographics
NPI:1528392727
Name:HALSELL, CAMERON MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:MICHELLE
Last Name:HALSELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:405-341-1557
Mailing Address - Fax:405-341-5615
Practice Address - Street 1:105 S BRYANT AVE
Practice Address - Street 2:#304
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6399
Practice Address - Country:US
Practice Address - Phone:405-341-1557
Practice Address - Fax:405-341-5615
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN3712207V00000X
OK5220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200433530AMedicaid
OKOKA104683Medicare PIN