Provider Demographics
NPI:1538154596
Name:CAMACHO, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:CAMACHO
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:PO BOX 160817
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0817
Mailing Address - Country:US
Mailing Address - Phone:904-733-3992
Mailing Address - Fax:904-737-4344
Practice Address - Street 1:4131 UNIVERSITY BLVD S STE 8
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4351
Practice Address - Country:US
Practice Address - Phone:904-733-3992
Practice Address - Fax:904-737-4344
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-06-05
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLME0047248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04390WOtherMEDICARE
FL047777000Medicaid
FL1538154596Medicare PIN
FLD51004Medicare UPIN