Provider Demographics
NPI:1477132959
Name:CAMPOS, ZACHARY RYAN (DO)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RYAN
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BRYCEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3008
Mailing Address - Country:US
Mailing Address - Phone:210-204-6616
Mailing Address - Fax:
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8204
Practice Address - Country:US
Practice Address - Phone:407-303-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program