Individual
GRISELDA CAMACHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106
(806) 414-9100
(806) 354-5717
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9100
(806) 354-5717
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
Q4373
TX
208M00000X
Hospitalist Physician
Q4373
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200814370A
—
OK
05
—
349519404
—
TX
05
—
349519405
—
TX
05
—
41259785
—
NM
Enumeration date
04/18/2012
Last updated
03/01/2019
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