Provider Demographics
NPI:1609130269
Name:DERBYSHIRE, CAMERON E (PA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:E
Last Name:DERBYSHIRE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24410
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0451
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:541-997-9650
Practice Address - Street 1:2400 HARTMAN LN STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1119
Practice Address - Country:US
Practice Address - Phone:541-334-3350
Practice Address - Fax:541-746-4569
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA158631363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646843Medicaid
OR500646843Medicaid