MEDICARE: DR. DOUGLAS ALLAN 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	207Q00000X	Family Medicine Physician	MD00036865	WA
2	208M00000X	Hospitalist Physician	MD00036865	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2209CA	OTHER	WA	REGENCE
2	0200245	OTHER	WA	LABOR & INDUSTRIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548206733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS ALLAN CAMP MD

Provider Business Mailing Address
First Line	:	1455 BATTERSBY AVE
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3634
Country	:	US
Telephone Number	:	253-426-6341
Fax Number	:	360-377-6956

Provider Business Practice Location Address
First Line	:	1455 BATTERSBY AVE
Second Line	:
City	:	ENUMCLAW
State	:	WA
Zip	:	98022-3634
Country	:	US
Telephone Number	:	253-426-6341
Fax Number	:	360-377-6956

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/17/2021

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