Provider Demographics
NPI:1528402526
Name:EARL, CAMERON LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:LEE
Last Name:EARL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 E 1000 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3369
Mailing Address - Country:US
Mailing Address - Phone:801-427-4902
Mailing Address - Fax:
Practice Address - Street 1:10864 TEXAS HEALTH TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4897
Practice Address - Country:US
Practice Address - Phone:817-702-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9743845-1204207P00000X
TXBP10045847207P00000X
TXQ2439207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ2439OtherTEXAS MEDICAL LICENSE
UT9743845-1204OtherUTAH MEDICAL LICENSE