Healthcare Provider Details

I. General information

NPI: 1225052285
Provider Name (Legal Business Name): ANDREW BRUCE CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 NE 1ST ST APT 10
FORT LAUDERDALE FL
33301-3800
US

IV. Provider business mailing address

27005 KNICKERBOCKER RD
BAY VILLAGE OH
44140-2383
US

V. Phone/Fax

Practice location:
  • Phone: 954-760-4306
  • Fax: 954-760-4306
Mailing address:
  • Phone: 888-365-5514
  • Fax: 800-616-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME97339
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number153691-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA08178100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD044591L
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME97339
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: