Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME80232 | FL |
NPI | 1003928854 |
---|---|
Provider Name | Dr. Mario A Camps |
First Address | Melbourne, FL 32901-3111 |
Second Address | Melbourne, FL 32901-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35347 | BCBSFL (01) | FL |
H17687 | (02) | FL |