Provider Demographics
NPI:1629096870
Name:ANDERSON, CAMERON D (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:D
Last Name:ANDERSON
Suffix:
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 1:39 PROFESSIONAL WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1675
Mailing Address - Country:US
Mailing Address - Phone:801-465-3201
Mailing Address - Fax:801-465-2889
Practice Address - Street 1:39 PROFESSIONAL WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1675
Practice Address - Country:US
Practice Address - Phone:801-465-3201
Practice Address - Fax:801-465-2889
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT361821-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD2677Medicaid
005560401Medicare ID - Type Unspecified
UTD2677Medicaid