Provider Demographics
NPI:1154364198
Name:CAMERO, ELVA ALEJANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:ELVA
Middle Name:ALEJANDRO
Last Name:CAMERO
Suffix:
Gender:F
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 1540
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-1540
Mailing Address - Country:US
Mailing Address - Phone:940-683-0036
Mailing Address - Fax:940-683-0038
Practice Address - Street 1:1905 DOCTORS HOSPITAL DR
Practice Address - Street 2:SUITE33
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2260
Practice Address - Country:US
Practice Address - Phone:940-683-0036
Practice Address - Fax:940-683-0038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5082207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8X3031OtherBC-BS IND NUMBER
TXJ5082OtherDR STATE NUMBER
TXJ5082OtherDR STATE NUMBER
TXF91419Medicare UPIN