Provider Demographics
NPI:1811992936
Name:CARMODY, CAMERON N (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:N
Last Name:CARMODY
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 1:17051 DALLAS PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-7108
Mailing Address - Country:US
Mailing Address - Phone:214-370-3535
Mailing Address - Fax:214-370-0004
Practice Address - Street 1:17051 DALLAS PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7108
Practice Address - Country:US
Practice Address - Phone:214-370-3535
Practice Address - Fax:214-370-0004
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2832174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8617NOMedicare PIN
TXF49109Medicare UPIN