Provider Demographics
NPI:1619924677
Name:CAMERON, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:GASKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6465 S YALE AVE
Mailing Address - Street 2:SUITE 507
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7823
Mailing Address - Country:US
Mailing Address - Phone:918-481-2760
Mailing Address - Fax:918-481-2775
Practice Address - Street 1:6465 S YALE AVE
Practice Address - Street 2:SUITE 507
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7823
Practice Address - Country:US
Practice Address - Phone:918-481-2760
Practice Address - Fax:918-481-2775
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26208207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058420AMedicaid
OK157796Medicare UPIN
OKOK401351Medicare PIN