Provider Demographics
NPI:1336249960
Name:CAMACHO, LUIS HERNANDO (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:HERNANDO
Last Name:CAMACHO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1224
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-796-1200
Mailing Address - Fax:713-795-0735
Practice Address - Street 1:6560 FANNIN STREET
Practice Address - Street 2:SUITE 1224
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-796-1200
Practice Address - Fax:713-795-0735
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2829207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148041001Medicaid
TX8P0572OtherHMO BLUE
01065744OtherAMERIGROUP
01065744OtherAMERIGROUP
TX8P0572OtherHMO BLUE