Individual
DR. CAMERON R. GONGWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4440 NORTH PORTAGE AVENUE, SOUTH BEND, IN 46628-8579
(574) 204-6200
(574) 288-1426
Mailing address
4440 NORTH PORTAGE AVENUE, SOUTH BEND, IN 46628-8579
(574) 204-6200
(574) 288-1426
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01038547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01038547A
LICENSE
IN
01
—
01038547B
CONTROLLED SUBSTANCE REG
IN
05
—
100092640
—
IN
Enumeration date
07/17/2006
Last updated
07/29/2016
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