Provider Demographics
NPI:1538696455
Name:WALES, CAMERON
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:
Last Name:WALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8381 RIVERWALK PARK BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8760
Mailing Address - Country:US
Mailing Address - Phone:239-242-1940
Mailing Address - Fax:239-772-5440
Practice Address - Street 1:14 DEL PRADO BLVD N STE 201
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2797
Practice Address - Country:US
Practice Address - Phone:239-242-1940
Practice Address - Fax:239-772-5440
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157824207ND0900X
IDM-16213207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM-16213OtherMEDICAL LICENSE