Provider Demographics
NPI:1881759397
Name:KAMELHAR, AARON (LSA, CST/CFA)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:KAMELHAR
Suffix:
Gender:M
Credentials:LSA, CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 WINSTED DR APT 5108
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3887
Mailing Address - Country:US
Mailing Address - Phone:214-533-8409
Mailing Address - Fax:
Practice Address - Street 1:2210 WINSTED DR APT 5108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3887
Practice Address - Country:US
Practice Address - Phone:214-533-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00545363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX752613157OtherTAX ID