Healthcare Provider Details

I. General information

NPI: 1609240613
Provider Name (Legal Business Name): BENJAMIN C CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2015
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6007 E BASELINE RD STE 101
MESA AZ
85206-4801
US

IV. Provider business mailing address

6007 E BASELINE RD STE 101
MESA AZ
85206-4801
US

V. Phone/Fax

Practice location:
  • Phone: 480-833-3698
  • Fax:
Mailing address:
  • Phone: 480-833-3698
  • Fax: 480-833-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA147542
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01082001A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number62162
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number62162
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number01082001A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: