Healthcare Provider Details

I. General information

NPI: 1255471926
Provider Name (Legal Business Name): ANN MCCAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ESQUILA RD
SANTA FE NM
87508-8739
US

IV. Provider business mailing address

11 ESQUILA RD
SANTA FE NM
87508-8739
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-3622
  • Fax: 505-466-2690
Mailing address:
  • Phone: 505-466-3622
  • Fax: 505-466-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number94-327
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: