Provider Demographics
NPI:1740020221
Name:MCCAMISH, MARK ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MCCAMISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6004 COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1223
Mailing Address - Country:US
Mailing Address - Phone:805-660-1244
Mailing Address - Fax:
Practice Address - Street 1:6004 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1223
Practice Address - Country:US
Practice Address - Phone:805-660-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57711207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine