Provider Demographics
NPI:1104863273
Name:MANUEL F CAMACHO JR MD PA
Entity Type:Organization
Organization Name:MANUEL F CAMACHO JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-264-8333
Mailing Address - Street 1:7500 SW 8TH ST
Mailing Address - Street 2:#302
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144
Mailing Address - Country:US
Mailing Address - Phone:305-264-8333
Mailing Address - Fax:305-264-8243
Practice Address - Street 1:7500 SW 8TH ST
Practice Address - Street 2:#302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-264-8333
Practice Address - Fax:305-264-8243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26655208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95311Medicare PIN
D63411Medicare UPIN