Provider Demographics
NPI:1396922415
Name:ESMKHANI, CAMERON CODY (DO)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:CODY
Last Name:ESMKHANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:813-778-0444
Mailing Address - Fax:813-355-5017
Practice Address - Street 1:38135 MARKET SQ
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7505
Practice Address - Country:US
Practice Address - Phone:813-778-0444
Practice Address - Fax:813-355-5017
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLNONE207R00000X
FLOS13112207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015121700Medicaid
FL1519YOtherBCBS
FL1519YOtherBCBS
FLIH382YMedicare PIN