Provider Demographics
NPI:1164418992
Name:CAMILLO, FRANCIS X (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:X
Last Name:CAMILLO
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 1:6005 PARK AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5214
Mailing Address - Country:US
Mailing Address - Phone:901-767-9500
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE
Practice Address - Street 2:STE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5214
Practice Address - Country:US
Practice Address - Phone:901-844-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2019-08-07
Deactivation Date:2018-07-04
Deactivation Code:
Reactivation Date:2018-07-18
Provider Licenses
StateLicense IDTaxonomies
TN35064207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3870194Medicaid
MS02581773Medicaid
TN3870194Medicaid