Provider Demographics
NPI:1831497437
Name:RONALD G CAMPOS, MD INC
Entity Type:Organization
Organization Name:RONALD G CAMPOS, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-943-1333
Mailing Address - Street 1:1844 SAN MIGUEL DR STE 307
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4963
Mailing Address - Country:US
Mailing Address - Phone:925-943-1333
Mailing Address - Fax:925-933-1822
Practice Address - Street 1:1844 SAN MIGUEL DR STE 307
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4963
Practice Address - Country:US
Practice Address - Phone:925-943-1333
Practice Address - Fax:925-933-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-05
Last Update Date:2011-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG00034573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG345730Medicaid
CAG345730Medicaid