Healthcare Provider Details

I. General information

NPI: 1629339155
Provider Name (Legal Business Name): LEONARDO A CAMPOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

IV. Provider business mailing address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-6633
  • Fax: 541-383-4577
Mailing address:
  • Phone: 541-382-6633
  • Fax: 541-383-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD197126
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD197126
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02584
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD14849
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number276816
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: