Provider Demographics
NPI:1598757452
Name:CAMACHO, SAMUEL ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ALBERT
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-229-7554
Mailing Address - Fax:503-229-7287
Practice Address - Street 1:10201 SE MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-257-0959
Practice Address - Fax:503-257-3457
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD21405207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134800Medicaid
OR134800Medicaid
ORA51777Medicare UPIN
OR103072Medicare PIN