Healthcare Provider Details

I. General information

NPI: 1740494822
Provider Name (Legal Business Name): MATTHEW P CAMPBELL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N AKERS ST
VISALIA CA
93291-5121
US

IV. Provider business mailing address

116 N AKERS ST
VISALIA CA
93291-5121
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-4118
  • Fax: 559-625-6004
Mailing address:
  • Phone: 559-625-4118
  • Fax: 559-625-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA72234
License Number StateCA

VIII. Authorized Official

Name: DR. MATTHEW PETER CAMPBELL
Title or Position: OWNER
Credential: M.D.
Phone: 559-625-4118