MEDICARE: VICTORIA JEAN CAMP DPM, PA

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	213E00000X	Podiatrist	PO3094	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184659484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA JEAN CAMP DPM, PA

Provider Business Mailing Address
First Line	:	150 SOUTHPARK BLVD
Second Line	:	STE 202
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086
Country	:	US
Telephone Number	:	904-810-0391
Fax Number	:	904-810-0392

Provider Business Practice Location Address
First Line	:	1093 A1A BEACH BLVD
Second Line	:	PMB 235
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32080-6733
Country	:	US
Telephone Number	:	904-814-4904
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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