Provider Demographics
NPI:1922390558
Name:CULVER, CAMERON B (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:B
Last Name:CULVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CAMERON
Other - Middle Name:BLAKE
Other - Last Name:CULVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1406 E MAIN ST
Mailing Address - Street 2:SUITE 200 #108
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5338
Mailing Address - Country:US
Mailing Address - Phone:713-823-5266
Mailing Address - Fax:
Practice Address - Street 1:3109 6TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-3800
Practice Address - Country:US
Practice Address - Phone:817-679-0133
Practice Address - Fax:817-426-8111
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012783492084P0800X
390200000X
TXP76292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358163OtherMEDICARE PTAN