Healthcare Provider Details

I. General information

NPI: 1154595437
Provider Name (Legal Business Name): ALAN B CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 3RD AVE N
ST PETERSBURG FL
33701-2703
US

IV. Provider business mailing address

863 3RD AVE N
ST PETERSBURG FL
33701-2703
US

V. Phone/Fax

Practice location:
  • Phone: 727-821-1200
  • Fax: 727-321-6412
Mailing address:
  • Phone: 727-821-1200
  • Fax: 727-321-6412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME7528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: