Provider Demographics
NPI:1912438235
Name:CAMP, BRYAN M (DPM)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:M
Last Name:CAMP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 UNION ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2694
Mailing Address - Country:US
Mailing Address - Phone:765-449-4758
Mailing Address - Fax:
Practice Address - Street 1:2020 UNION ST STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2694
Practice Address - Country:US
Practice Address - Phone:765-449-4758
Practice Address - Fax:765-449-0659
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001349A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN07001349AOtherDPM LICENSE
IN07001349BOtherCSR LICENSE