Provider Demographics
NPI:1972568228
Name:CAMP, RODNEY (DO)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:CAMP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TRANCAS ST STE 350
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2959
Mailing Address - Country:US
Mailing Address - Phone:707-251-1862
Mailing Address - Fax:
Practice Address - Street 1:34 MARK WEST SPRINGS RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1766
Practice Address - Country:US
Practice Address - Phone:707-541-7900
Practice Address - Fax:707-573-5411
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167756-1207RG0100X
ORDO213174207RG0100X
CA20A15726207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01220424Medicaid
NY910550OtherMVP PROVIDER #
NY910550OtherMVP PROVIDER #
NY25B781Medicare ID - Type Unspecified