Individual
GERALD R CAMERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
404 S LEWIS LN, CARBONDALE, IL 62901-3547
(618) 519-9200
Mailing address
109 CALIFORNIA ST, CARTERVILLE, IL 62918-1923
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001260
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001260
STATE LICENSE NUMBER
IL
01
—
132566
HEALTH ALLIANCE
IL
05
—
370966854002
—
IL
05
—
370966854005
—
IL
05
—
370966854006
—
IL
05
—
370966854015
—
IL
01
—
CF3444
MEDICARE RR
IL
Enumeration date
08/22/2006
Last updated
03/17/2018
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