Provider Demographics
NPI:1396761359
Name:CAMERON, J JEFFERY (MD)
Entity type:Individual
Prefix:MR
First Name:J JEFFERY
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 1:13170 RAVENNA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7022
Mailing Address - Country:US
Mailing Address - Phone:440-214-9277
Mailing Address - Fax:440-214-9341
Practice Address - Street 1:13170 RAVENNA RD STE 108
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7022
Practice Address - Country:US
Practice Address - Phone:440-214-9277
Practice Address - Fax:440-214-9341
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35051544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0964756Medicaid
OH0964756Medicaid
OHCA9305281Medicare ID - Type Unspecified