Provider Demographics
NPI:1730142647
Name:DE CAMPOS, JULIET MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:MARIE
Last Name:DE CAMPOS
Suffix:
Gender:F
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:PO BOX 30010
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1010
Mailing Address - Country:US
Mailing Address - Phone:850-479-3320
Mailing Address - Fax:850-479-8789
Practice Address - Street 1:4900 BAYOU BLVD STE 107
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2543
Practice Address - Country:US
Practice Address - Phone:850-741-2814
Practice Address - Fax:850-741-2948
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69848207X00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253484300Medicaid
AL009907575Medicaid
200043453OtherMEDICARE RAILROAD
AL590-54047OtherBLUE CROSS BLUE SHIELD
FL42560OtherBLUE CROSS BLUE SHIELD
FL253484300Medicaid
AL009907575Medicaid