Provider Demographics
NPI:1952398463
Name:WILLIAMS, CAMERON SEYMOUR (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:SEYMOUR
Last Name:WILLIAMS
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:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-1276
Mailing Address - Country:US
Mailing Address - Phone:801-423-3306
Mailing Address - Fax:801-423-3309
Practice Address - Street 1:300 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4218
Practice Address - Country:US
Practice Address - Phone:435-637-4864
Practice Address - Fax:435-636-4896
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167155-1205207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT167155-1205OtherSTATE LICENSE
UT06887Medicaid
D07382Medicare UPIN
UT06887Medicaid