Healthcare Provider Details

I. General information

NPI: 1104884162
Provider Name (Legal Business Name): WASHINGTON OCAMPO SUMABAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S MAIN ST
BLUFFTON IN
46714-2047
US

IV. Provider business mailing address

117 S MAIN ST
BLUFFTON IN
46714-2047
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-9265
  • Fax: 260-824-9267
Mailing address:
  • Phone: 260-824-9265
  • Fax: 260-824-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01042731
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: