MEDICARE: DR. RICHARD F. CAMINO GAZTAMBIDE M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	070352	GA

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
2	070352	OTHER	GA	GEORGIA MEDICAL LICENSE

General Provider Information

NPI Number	:	1184803116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD F. CAMINO GAZTAMBIDE M.D.

Provider Business Mailing Address
First Line	:	1499 WALTON WAY STE 1400
Second Line	:	ATTN: D. RAIFORD
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2603
Country	:	US
Telephone Number	:	706-828-8401
Fax Number	:	706-722-7235

Provider Business Practice Location Address
First Line	:	997 SAINT SEBASTIAN WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30912-2613
Country	:	US
Telephone Number	:	706-721-6597
Fax Number	:	706-721-6602

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

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/03/2016

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