Provider Demographics
NPI:1013993278
Name:CAMERON, DERRICK LEON (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:LEON
Last Name:CAMERON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 HIGHWAY 225
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-2434
Mailing Address - Country:US
Mailing Address - Phone:713-246-6303
Mailing Address - Fax:713-246-7811
Practice Address - Street 1:5900 HIGHWAY 225
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-2434
Practice Address - Country:US
Practice Address - Phone:713-246-6303
Practice Address - Fax:713-246-7811
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-086502207Q00000X
TXK2147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG76534Medicare UPIN