Provider Demographics
NPI:1912950023
Name:CAMERON, BLAINE S (MD)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:S
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 1:6586 HYPOLUXO RD
Mailing Address - Street 2:SUITE 334
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6080 BOYNTON BEACH BLVD
Practice Address - Street 2:#100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3588
Practice Address - Country:US
Practice Address - Phone:877-412-7272
Practice Address - Fax:561-967-0954
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86864207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
L14783Medicare UPIN