Individual
JUSTIN CAMERON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
712 JAY ST, FOSSIL, OR 97830-8371
(541) 763-2725
Mailing address
PO BOX 37, FOSSIL, OR 97830-0037
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000X
—
WA
Enumeration date
08/14/2018
Last updated
01/23/2020
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