Healthcare Provider Details

I. General information

NPI: 1598796237
Provider Name (Legal Business Name): JAMES E CAMPBELL MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 N 51ST AVE 203
GLENDALE AZ
85306-4800
US

IV. Provider business mailing address

PO BOX 39179
PHOENIX AZ
85069-9179
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-2400
  • Fax: 602-439-1414
Mailing address:
  • Phone: 602-395-0718
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5458
License Number StateAZ

VIII. Authorized Official

Name: SHANNON WHITE
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-443-2325