Provider Demographics
NPI:1144275272
Name:SMITH, CAMERON GORDON HAMPTON (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:GORDON HAMPTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PRIMARY CARE INTERNAL MEDICINE RESIDENCY L2104
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-1234
Mailing Address - Country:US
Mailing Address - Phone:860-679-4017
Mailing Address - Fax:860-679-1621
Practice Address - Street 1:16045 1ST AVE S FL 1
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1401
Practice Address - Country:US
Practice Address - Phone:206-965-4100
Practice Address - Fax:206-965-4119
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60631260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB36821Medicare ID - Type Unspecified
U94867Medicare UPIN