Provider Demographics
NPI:1689629362
Name:CAMPUS, HIEU T (MD)
Entity Type:Individual
Prefix:
First Name:HIEU
Middle Name:T
Last Name:CAMPUS
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 1:655 HARMON LOOP RD
Mailing Address - Street 2:STE 108
Mailing Address - City:DEDEDO
Mailing Address - State:GU
Mailing Address - Zip Code:96929-6544
Mailing Address - Country:US
Mailing Address - Phone:206-660-3955
Mailing Address - Fax:
Practice Address - Street 1:655 HARMON LOOP ROAD
Practice Address - Street 2:STE. 108
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-9692
Practice Address - Country:US
Practice Address - Phone:671-633-4447
Practice Address - Fax:671-633-4452
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60023211207Q00000X
390200000X
GUM-1781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program