Healthcare Provider Details

I. General information

NPI: 1407017387
Provider Name (Legal Business Name): JERMAINE CAMPBELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N COURSE DR APT 125
POMPANO BEACH FL
33069-3030
US

IV. Provider business mailing address

12491 BAYWIND CT
BOCA RATON FL
33428-4704
US

V. Phone/Fax

Practice location:
  • Phone: 754-264-6061
  • Fax: 844-321-1486
Mailing address:
  • Phone: 754-264-6061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS13774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: