Doctor Name: | JOHANNA MILITZA CAMACHO |
NPI Number: | 1679756399 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 16947 |
Business Practice Address: | 24276 166 Th St Airport Road Eagle Butte, SD - 57625 |
Business Phone Number: | 7875199355 |
Business Fax Number: | |
Mailing Address: | Po Box 1910, EAGLE BUTTE |
State: | SD |
Postal Code: | 576251910 |
Phone Number: | 7875199355 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2007 |
NPI Last Update Date: | 09/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 16947 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |