Healthcare Provider Details

I. General information

NPI: 1386601896
Provider Name (Legal Business Name): JAMES C CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 UNIVERSITY BLVD S STE 104 CREDENTIALING DEPARTMENT
JACKSONVILLE FL
32216-2757
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-1171
  • Fax: 904-727-3550
Mailing address:
  • Phone: 904-398-3760
  • Fax: 904-727-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME50278
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME50278
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME50278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: