Provider Demographics
NPI:1699772749
Name:DEL CAMPO, ONOFRE S (MD)
Entity type:Individual
Prefix:
First Name:ONOFRE
Middle Name:S
Last Name:DEL CAMPO
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 1:1652 RIVER BLUFF RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-4544
Mailing Address - Country:US
Mailing Address - Phone:904-744-5543
Mailing Address - Fax:
Practice Address - Street 1:6665 BANBURY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5416
Practice Address - Country:US
Practice Address - Phone:904-744-5543
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00250282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21359Medicare UPIN
FL15352Medicare ID - Type UnspecifiedPROVIDER NUMBER