Individual
MARC T CAMPOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1103 N BALDWIN AVENUE, MARION, IN 46952-2536
(765) 660-7480
(765) 382-4495
Mailing address
330 N WABASH, G20, MARION, IN 46952-2600
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
IN
363AM0700X
Medical Physician Assistant
Primary
4367
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001216651
ANTHEM
IN
Enumeration date
06/25/2013
Last updated
07/01/2019
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