Healthcare Provider Details

I. General information

NPI: 1114919347
Provider Name (Legal Business Name): WILLIAM B CAMPBELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105A RIDGECREST
NIXA MO
65714-7807
US

IV. Provider business mailing address

105A RIDGECREST
NIXA MO
65714-7807
US

V. Phone/Fax

Practice location:
  • Phone: 417-725-8250
  • Fax: 417-725-8253
Mailing address:
  • Phone: 417-725-8250
  • Fax: 417-725-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR2D18
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: