Healthcare Provider Details

I. General information

NPI: 1285641076
Provider Name (Legal Business Name): ALFONSO CAMPOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BRUCE B DOWNS BLVD
TAMPA FL
33612-4742
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-8760
  • Fax: 813-259-8765
Mailing address:
  • Phone: 813-974-2201
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME40853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: