Healthcare Provider Details

I. General information

NPI: 1215953310
Provider Name (Legal Business Name): ROBERT S CAMPBELL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12207 PECOS ST #300
WESTMINSTER CO
80031-3400
US

IV. Provider business mailing address

720 S COLORADO BLVD SUITE 220A
GLENDALE CO
80246-1912
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-0445
  • Fax: 303-429-5088
Mailing address:
  • Phone: 303-584-8231
  • Fax: 866-210-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number46
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: