Basic Information
| Provider Information | |||||||||
| NPI: | 1215220934 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMERON | ||||||||
| FirstName: | JIOR | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535963300 | ||||||||
| FaxNumber: | 2535963301 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 S L ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984053720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534031420 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2011 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 72498 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 2080P0204X | MD60587379 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208000000X | MD60587379 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.