Healthcare Provider Details

I. General information

NPI: 1093049926
Provider Name (Legal Business Name): HECTOR O'NIEL CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HECTOR O'NIEL CAMPBELL M.D.

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 DEMERS AVE
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax:
Mailing address:
  • Phone: 701-780-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD21302
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301094897
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number4301094897
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberMD21302
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberPT19718
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: