Healthcare Provider Details

I. General information

NPI: 1952497810
Provider Name (Legal Business Name): CLAY I. CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8299 MT HIGHWAY 35
BIGFORK MT
59911-3583
US

IV. Provider business mailing address

8299 MT HIGHWAY 35
BIGFORK MT
59911-3583
US

V. Phone/Fax

Practice location:
  • Phone: 406-837-5541
  • Fax: 406-837-5543
Mailing address:
  • Phone: 406-837-5541
  • Fax: 406-837-5543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-6065
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number90015
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: