MEDICARE: DR. JOHN THOMAS CAMPBELL II M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	40745	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053373415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN THOMAS CAMPBELL II M.D.

Provider Business Mailing Address
First Line	:	4386 TRAIL BOSS DR
Second Line	:	SUITE A
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-8666
Fax Number	:	303-688-8260

Provider Business Practice Location Address
First Line	:	4386 TRAIL BOSS DR
Second Line	:	SUITE A
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-8666
Fax Number	:	303-688-8260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	01/29/2011

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