Healthcare Provider Details

I. General information

NPI: 1871664557
Provider Name (Legal Business Name): PETER J CAMPBELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E CAMELBACK RD SUITE 180
PHOENIX AZ
85018-2311
US

IV. Provider business mailing address

3200 E CAMELBACK RD SUITE 180
PHOENIX AZ
85018-2311
US

V. Phone/Fax

Practice location:
  • Phone: 602-393-4263
  • Fax: 602-393-2329
Mailing address:
  • Phone: 602-393-4263
  • Fax: 602-393-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24254
License Number StateAZ

VIII. Authorized Official

Name: MRS. ARASELI FERNANDEZ
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 602-393-4263