MEDICARE: CRAIG J CAMPBELL DPM PC

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	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1922334317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRAIG J CAMPBELL DPM PC

Provider Business Mailing Address
First Line	:	5255 S 4015 W
Second Line	:	SUITE 140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-4258
Country	:	US
Telephone Number	:	801-969-1434
Fax Number	:	801-969-1474

Provider Business Practice Location Address
First Line	:	5255 S 4015 W
Second Line	:	SUITE 140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-4258
Country	:	US
Telephone Number	:	801-969-1434
Fax Number	:	801-969-1474

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRAIG J CAMPBELL
Credential	:	DPM
Telephone Number	:	801-969-1434

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	05/01/2012

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