1255596573 NPI number — DR. LASHONDRIA RENEE CAMP M.D.

Table of content: DR. LASHONDRIA RENEE CAMP M.D. (NPI 1255596573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255596573 NPI number — DR. LASHONDRIA RENEE CAMP M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMP
Provider First Name:
LASHONDRIA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255596573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1198
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79604-1198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-670-4220
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 PINE ST
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79601-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-670-4333
Provider Business Practice Location Address Fax Number:
325-670-4336
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  P3987 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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