Provider Demographics
NPI:1336111772
Name:KAMPS, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KAMPS
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:ST MICHAELS
Mailing Address - State:AZ
Mailing Address - Zip Code:86511-0370
Mailing Address - Country:US
Mailing Address - Phone:928-810-3814
Mailing Address - Fax:928-810-3801
Practice Address - Street 1:359-A W. HIGHWAY 264
Practice Address - Street 2:
Practice Address - City:ST. MICHAELS
Practice Address - State:AZ
Practice Address - Zip Code:86511-0370
Practice Address - Country:US
Practice Address - Phone:928-810-3814
Practice Address - Fax:928-810-3801
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM65-38207Q00000X
AZ1721208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14563Medicaid
NM1456OtherBCBS
AZ239914Medicaid
C97876Medicare UPIN