Healthcare Provider Details

I. General information

NPI: 1124007836
Provider Name (Legal Business Name): DARREN CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 PINION DR 10TH MEDICAL GROUP
USAF ACADEMY CO
80840-2502
US

IV. Provider business mailing address

4102 PINION DR 10TH MEDICAL GROUP
USAF ACADEMY CO
80840-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-5962
  • Fax:
Mailing address:
  • Phone: 719-333-5962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5230245-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47337
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5230245-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: