Provider Demographics
NPI:1356987192
Name:CAMERON, BLADE RICHARD
Entity type:Individual
Prefix:
First Name:BLADE
Middle Name:RICHARD
Last Name:CAMERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N10593 RED RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BIRNAMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54414-8491
Mailing Address - Country:US
Mailing Address - Phone:715-903-0227
Mailing Address - Fax:
Practice Address - Street 1:N10593 RED RIVER RD
Practice Address - Street 2:
Practice Address - City:BIRNAMWOOD
Practice Address - State:WI
Practice Address - Zip Code:54414-8491
Practice Address - Country:US
Practice Address - Phone:715-903-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer