Provider Demographics
NPI:1790776680
Name:LOUGHEIDE-CAMEJO, NATASHA (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:LOUGHEIDE-CAMEJO
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 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-332-0417
Mailing Address - Fax:239-334-9417
Practice Address - Street 1:930 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4444
Practice Address - Country:US
Practice Address - Phone:239-332-0417
Practice Address - Fax:863-675-1346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85797208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH74345Medicare UPIN
FL47878ZMedicare ID - Type Unspecified