Provider Demographics
NPI:1912122698
Name:CAMP, GREGORY VANSANTVOORD (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:VANSANTVOORD
Last Name:CAMP
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 1:2014 SE 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3435
Mailing Address - Country:US
Mailing Address - Phone:503-235-9299
Mailing Address - Fax:503-236-2145
Practice Address - Street 1:13505 SE RIVER RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-8038
Practice Address - Country:US
Practice Address - Phone:505-652-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORGVSC10104Medicare ID - Type Unspecified
ORA08032Medicare UPIN