Provider Demographics
NPI:1942373030
Name:WAMPLER, CAMERON (PA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:WAMPLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W LBJ FWY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-556-2885
Mailing Address - Fax:972-506-8733
Practice Address - Street 1:400 W LBJ FWY
Practice Address - Street 2:SUITE 330
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-556-2885
Practice Address - Fax:972-506-8733
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04917363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant