MEDICARE: ONOFRE S DEL CAMPO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0025028	FL

General Provider Information

NPI Number	:	1699772749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONOFRE S DEL CAMPO M.D.

Provider Business Mailing Address
First Line	:	1652 RIVER BLUFF RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-4544
Country	:	US
Telephone Number	:	904-744-5543
Fax Number	:

Provider Business Practice Location Address
First Line	:	6665 BANBURY RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-5416
Country	:	US
Telephone Number	:	904-744-5543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/09/2007

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