Basic Information
Provider Information
NPI: 1669444170
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PARHAM
FirstName: CAMERON
MiddleName: ALA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1231
Address2:  
City: HAVRE
State: MT
PostalCode: 595011231
CountryCode: US
TelephoneNumber: 4062621302
FaxNumber: 4062651651
Practice Location
Address1: 30 13TH ST
Address2:  
City: HAVRE
State: MT
PostalCode: 595015222
CountryCode: US
TelephoneNumber: 4062652211
FaxNumber: 4062651651
Other Information
ProviderEnumerationDate: 02/07/2006
LastUpdateDate: 02/14/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X6718MTY Allopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
166944417005MT MEDICAID
93002319901 MEDICARE RAILROADOTHER
00000064101MTBCBS ER GROUPOTHER


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