Provider Demographics
NPI:1154539401
Name:CAMP, MATTHEW CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARROLL
Last Name:CAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 OCCIDENTAL CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2685
Mailing Address - Country:US
Mailing Address - Phone:909-747-4489
Mailing Address - Fax:
Practice Address - Street 1:1066 OCCIDENTAL CIR
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2685
Practice Address - Country:US
Practice Address - Phone:909-747-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA980372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery