Provider Demographics
NPI:1366505778
Name:CAMPOS, RONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:# 307
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4963
Mailing Address - Country:US
Mailing Address - Phone:925-943-1333
Mailing Address - Fax:925-933-1822
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:# 307
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4963
Practice Address - Country:US
Practice Address - Phone:925-943-1333
Practice Address - Fax:925-933-1822
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G34573020Medicare ID - Type Unspecified
A45981Medicare UPIN