Provider Demographics
NPI:1023198280
Name:CAMPOS, JUAN IGNACIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:IGNACIO
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2370
Mailing Address - Country:US
Mailing Address - Phone:210-696-9292
Mailing Address - Fax:210-690-8815
Practice Address - Street 1:16019 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2370
Practice Address - Country:US
Practice Address - Phone:210-696-9292
Practice Address - Fax:210-690-8815
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK80472084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0092HKOtherBCBS
TX046633602Medicaid
TX046633602Medicaid
TX00357QMedicare ID - Type Unspecified