MEDICARE: NICOLE DECAMP, MD, PC

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	207N00000X	Dermatology Physician	19832	OK

General Provider Information

NPI Number	:	1255455408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE DECAMP, MD, PC

Provider Business Mailing Address
First Line	:	PO BOX 2382
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-2382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 N SANTA FE AVE
Second Line	:	#205
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7538
Country	:	US
Telephone Number	:	405-848-2800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE DECAMP
Credential	:	MD
Telephone Number	:	405-848-2800

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	10/11/2007

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