Healthcare Provider Details

I. General information

NPI: 1336192582
Provider Name (Legal Business Name): RODGER S CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WEST BLAIR DRIVE
STOCKTON MO
65785
US

IV. Provider business mailing address

106 WEST BLAIR DRIVE
STOCKTON MO
65785
US

V. Phone/Fax

Practice location:
  • Phone: 417-276-5620
  • Fax:
Mailing address:
  • Phone: 417-276-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number105976
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number105976
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: