Provider Demographics
NPI:1922648203
Name:POGUE, CAMERON RAY
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:RAY
Last Name:POGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MALCOLM ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-4341
Mailing Address - Country:US
Mailing Address - Phone:337-940-0362
Mailing Address - Fax:
Practice Address - Street 1:1011 MALCOLM ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-4341
Practice Address - Country:US
Practice Address - Phone:337-940-0362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist