Healthcare Provider Details

I. General information

NPI: 1720071384
Provider Name (Legal Business Name): DOUGLAS J CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 W US HIGHWAY 60
SUPERIOR AZ
85173-3400
US

IV. Provider business mailing address

5880 S HOSPITAL DR
GLOBE AZ
85501-9447
US

V. Phone/Fax

Practice location:
  • Phone: 520-689-2423
  • Fax:
Mailing address:
  • Phone: 928-402-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28543
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: