Provider Demographics
NPI:1457531022
Name:CAMPA, JOHN A III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CAMPA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ASCENCION
Other - Middle Name:JOHN
Other - Last Name:CAMPA
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E4
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1554
Mailing Address - Country:US
Mailing Address - Phone:505-508-1543
Mailing Address - Fax:505-554-2118
Practice Address - Street 1:7520 MONTGOMERY BLVD NE BLDG E4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1554
Practice Address - Country:US
Practice Address - Phone:505-508-1543
Practice Address - Fax:505-554-2118
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0652208VP0000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine