Provider Demographics
NPI:1396740874
Name:GIFFORD, CAMERON DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:DOUGLAS
Last Name:GIFFORD
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 1329
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2317
Practice Address - Country:US
Practice Address - Phone:812-676-4542
Practice Address - Fax:812-353-3713
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00444621OtherRAILROAD MEDICARE
NC129M5OtherBLUECROSS BLUESHIELD
NC801561OtherBLUE MEDICARE
NC89129M5Medicaid
NC89129M5Medicaid
NCP00444621OtherRAILROAD MEDICARE
NC2290953Medicare ID - Type Unspecified