Healthcare Provider Details

I. General information

NPI: 1346450970
Provider Name (Legal Business Name): JOHN CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

IV. Provider business mailing address

877 OAK PARK BLVD
PISMO BEACH CA
93449-3292
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-8450
  • Fax: 805-474-8454
Mailing address:
  • Phone: 805-474-8450
  • Fax: 805-474-8454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2007025194
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberC168949
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD041355
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: