Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A98037 | CA |
NPI | 1154539401 |
---|---|
Provider Name | Dr. Matthew Carroll Camp |
First Address | Redlands, CA 92374-2685 |
Second Address | Redlands, CA 92374-2685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |