MEDICARE: DR. TONI JEAN CAMP MD

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	2084P0800X	Psychiatry Physician	91-12	NM

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	:	1255350872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONI JEAN CAMP MD

Provider Business Mailing Address
First Line	:	3 CALLE SAN MARTIN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-7536
Country	:	US
Telephone Number	:	505-983-3905
Fax Number	:	505-820-0675

Provider Business Practice Location Address
First Line	:	3 CALLE SAN MARTIN
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87506-7536
Country	:	US
Telephone Number	:	505-983-3905
Fax Number	:	505-820-0675

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/02/2010

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