Individual
CHARLES MCCAMMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6235 RIVER CREST DR, SUITE L, RIVERSIDE, CA 92507-0758
(951) 413-1200
Mailing address
6235 RIVER CREST DR, SUITE L, RIVERSIDE, CA 92507-0758
(951) 413-1200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G51047
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G51047
LICENSE NUMBER
CA
Enumeration date
03/14/2007
Last updated
07/08/2007
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