Provider Demographics
NPI:1548206733
Name:CAMP, DOUGLAS ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALLAN
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 1:1455 BATTERSBY AVE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3634
Mailing Address - Country:US
Mailing Address - Phone:253-426-6341
Mailing Address - Fax:360-377-6956
Practice Address - Street 1:1455 BATTERSBY AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3634
Practice Address - Country:US
Practice Address - Phone:253-426-6341
Practice Address - Fax:360-377-6956
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036865207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2209CAOtherREGENCE
WA0200245OtherLABOR & INDUSTRIES
WA1012913Medicaid
WA1012913Medicaid
WA8803895Medicare ID - Type Unspecified