Provider Demographics
NPI:1801884978
Name:CAMPO, LAWRENCE J (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:CAMPO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:3135 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6823
Practice Address - Country:US
Practice Address - Phone:352-988-6200
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2022-08-10
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Provider Licenses
StateLicense IDTaxonomies
FLME58401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263733200Medicaid
FL263733200Medicaid
FL10880PMedicare PIN