MEDICARE: MR. BRIAN DAVID CAMPBELL USN-IDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1780645051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN DAVID CAMPBELL USN-IDC

Provider Business Mailing Address
First Line	:	3035C JOHN HANCOCK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32221-2405
Country	:	US
Telephone Number	:	904-542-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 SEWELLS POINT RD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-1756
Country	:	US
Telephone Number	:	757-853-0695
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	11/30/2009

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