Provider Demographics
NPI:1295734838
Name:CAMBRAY-FORKER, ELIZABETH JANE (DO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:CAMBRAY-FORKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14005
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-1405
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:431 S BATAVIA ST
Practice Address - Street 2:STE. 103
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3936
Practice Address - Country:US
Practice Address - Phone:714-538-6731
Practice Address - Fax:714-771-8369
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A62832085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
020A62830OtherBLUE SHIELD OF CA
300112802OtherRAILROAD MEDICARE
00AX62830 159OtherCALOPTIMA
053304CF39742OtherTRAILBLAZER
CA00AX62830Medicaid
W20A6283CMedicare PIN
W20A6283GMedicare PIN
F39742Medicare UPIN
W20A6283EMedicare PIN
W20A6283BMedicare PIN