Healthcare Provider Details

I. General information

NPI: 1265492011
Provider Name (Legal Business Name): GARY E CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 S MCCARRAN BLVD #18
RENO NV
89509-6135
US

IV. Provider business mailing address

PO BOX 20819
RENO NV
89510-0819
US

V. Phone/Fax

Practice location:
  • Phone: 775-823-1990
  • Fax: 775-823-1974
Mailing address:
  • Phone: 775-689-9117
  • Fax: 775-827-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5477
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: