Provider Demographics
NPI:1235154543
Name:CAMP, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:CAMP
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 1:4790 IRVINE BLVD
Mailing Address - Street 2:SUITE 105-342
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1973
Mailing Address - Country:US
Mailing Address - Phone:714-392-1182
Mailing Address - Fax:
Practice Address - Street 1:4790 IRVINE BLVD
Practice Address - Street 2:SUITE 105-342
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1973
Practice Address - Country:US
Practice Address - Phone:714-392-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32893207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35097Medicare UPIN