MEDICARE: DR. MARY ANN CAMPBELL 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	04-23296	KS
2	207Q00000X	Family Medicine Physician	12339	FL

General Provider Information

NPI Number	:	1053402354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANN CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	6101 PINE RIDGE RD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-3900
Country	:	US
Telephone Number	:	239-348-4221
Fax Number	:	913-338-4606

Provider Business Practice Location Address
First Line	:	8300 COLLIER BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-3549
Country	:	US
Telephone Number	:	239-348-4221
Fax Number	:	913-338-4606

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/01/2024

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