Basic Information
| Provider Information | |||||||||
| NPI: | 1376077321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMBRON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 405 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502191290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416286649 | ||||||||
| FaxNumber: | 6416286699 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 MONROE ST | ||||||||
| Address2: | |||||||||
| City: | PELLA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502191290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416286649 | ||||||||
| FaxNumber: | 6416286699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | DO-05484 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1376077321 | 05 | IA | MEDICAID | DO-05484 | 01 | IA | IOWA LICENSE | OTHER |