Provider Demographics
NPI:1881874006
Name:CAMERON, DONALD IAN (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:IAN
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 1:3125 TRANSVERSE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8008
Mailing Address - Country:US
Mailing Address - Phone:419-383-3760
Mailing Address - Fax:419-383-2957
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-3760
Practice Address - Fax:419-383-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047115C174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02534OtherUPIN
000000132630OtherANTHEM
OH0516061Medicaid
C02534OtherUPIN