Cameron Trace Landreth, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12024 Issued in TX

Practice address

12000 Huebner Rd Ste 104
San Antonio, TX 78230-1209

Phone

(210) 561-2422

Fax

(210) 561-2466

NPI assigned

Jun 27, 2018

Last updated

Apr 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1659866119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12000 HUEBNER RD STE 204",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301213",
            "telephone_number": "210-561-2422",
            "fax_number": "210-561-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12000 HUEBNER RD STE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301209",
            "telephone_number": "210-561-2422",
            "fax_number": "210-561-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRETH",
        "first_name": "CAMERON",
        "middle_name": "TRACE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-27",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "PA12024",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA12024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Landes
• Nancy Jane Landez, MD
• Mandy Landin, NP
• Michael Landin, PT, DPT
• Breanne Landivar, COTA
• Kaileen Landreth
• Katelyn Landreth
• Douglas Landrum
• William Landrum, LPC
• Adrianna Landry

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.