Provider Demographics
NPI:1356381479
Name:CAMERON, RICKY (MD)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:CAMERON
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7513207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101988712Medicaid
TX750818167022OtherTRICARE
TX101988709Medicaid
TXTIN PLUS 005OtherTRICARE
TX101988713Medicaid
TX101988710Medicaid
TX8EZ073OtherBCBS
TXTIN PLUS 015OtherTRICARE
TX0066LSOtherBLUE CROSS BLUE SHIELD
TX75-2616977-002OtherTRICARE
TXP00662563OtherRAIL ROAD
TXP00792105OtherRAIL ROAD
TX75-2616977-028OtherTRICARE
TX8AM870OtherBCBS
TX101988711Medicaid
TX080162299OtherRAIL ROAD
TX101988707Medicaid
TX75-2616977-001OtherTRICARE
TX750818167-044OtherTRICARE
TX8EZ073OtherBCBS
TX75-2616977-028OtherTRICARE
TX101988707Medicaid
TX101988709Medicaid
TX8L0912Medicare Oscar/Certification
TXG57665Medicare UPIN
TX611017Medicare PIN