Healthcare Provider Details

I. General information

NPI: 1710687926
Provider Name (Legal Business Name): CHARLES EDWARD CAMPBELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S ALAMO AVE
TUCSON AZ
85707-4402
US

IV. Provider business mailing address

4175 S ALAMO AVE
TUCSON AZ
85707-4402
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2778
  • Fax:
Mailing address:
  • Phone: 520-228-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2024038780
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: