Provider Demographics
NPI:1194780767
Name:DICK, CAMERON R (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:R
Last Name:DICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5090 N 40TH ST
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2111
Mailing Address - Country:US
Mailing Address - Phone:602-264-5685
Mailing Address - Fax:602-631-9870
Practice Address - Street 1:5090 N 40TH ST
Practice Address - Street 2:SUITE 122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2111
Practice Address - Country:US
Practice Address - Phone:602-264-5685
Practice Address - Fax:602-631-9870
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ27955207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G25788Medicare UPIN
29978Medicare ID - Type Unspecified