Healthcare Provider Details

I. General information

NPI: 1265423214
Provider Name (Legal Business Name): JOHN D CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 ELLIS ST STE 201
BOZEMAN MT
59715-8813
US

IV. Provider business mailing address

1450 ELLIS ST STE 201
BOZEMAN MT
59715-8813
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-0122
  • Fax: 406-587-5548
Mailing address:
  • Phone: 406-587-0122
  • Fax: 406-587-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number6828
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6828
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: