Provider Demographics
NPI:1679058986
Name:BADER, CAMERON (PA-C)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12469 EMERALD COAST PKWY W
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-8305
Mailing Address - Country:US
Mailing Address - Phone:506-543-3768
Mailing Address - Fax:850-654-3320
Practice Address - Street 1:4400 E HIGHWAY 20 STE 410
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9735
Practice Address - Country:US
Practice Address - Phone:850-654-3376
Practice Address - Fax:850-654-3320
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9112157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant