Provider Demographics
NPI:1952636672
Name:CHESNUT, CAMERON (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:CHESNUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S MCCLELLAN ST
Mailing Address - Street 2:SUITE 426
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2457
Mailing Address - Country:US
Mailing Address - Phone:509-456-8444
Mailing Address - Fax:509-455-9227
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 426
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-456-8444
Practice Address - Fax:509-455-9227
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD60448655207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program