Healthcare Provider Details

I. General information

NPI: 1457531022
Provider Name (Legal Business Name): JOHN A CAMPA III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ASCENCION JOHN CAMPA III MD

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 MONTGOMERY BLVD NE BLDG E4
ALBUQUERQUE NM
87109-1554
US

IV. Provider business mailing address

7520 MONTGOMERY BLVD NE BLDG E4
ALBUQUERQUE NM
87109-1554
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-1543
  • Fax: 505-554-2118
Mailing address:
  • Phone: 505-508-1543
  • Fax: 505-554-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD2007-0652
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD2007-0652
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: