Provider Demographics
NPI:1922389329
Name:SZOK, CAMERON MCDONALD (LAC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:MCDONALD
Last Name:SZOK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-3434
Mailing Address - Country:US
Mailing Address - Phone:817-913-2421
Mailing Address - Fax:
Practice Address - Street 1:1810 8TH AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1352
Practice Address - Country:US
Practice Address - Phone:817-913-2421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01294171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist