Provider Demographics
NPI:1306280029
Name:CAMERON, JULIANNE JEAN (DO)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:JEAN
Last Name:CAMERON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 N HESS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8716
Mailing Address - Country:US
Mailing Address - Phone:208-295-5772
Mailing Address - Fax:208-772-5275
Practice Address - Street 1:8880 N HESS ST STE 1
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8716
Practice Address - Country:US
Practice Address - Phone:208-295-5772
Practice Address - Fax:208-772-5275
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-0926207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1306280029Medicaid
ID1306280029Medicaid