Healthcare Provider Details

I. General information

NPI: 1447387501
Provider Name (Legal Business Name): DAVID CAMPBELL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD SUITE 120
EUGENE OR
97401
US

IV. Provider business mailing address

66 CLUB RD SUITE 120
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-345-2800
  • Fax: 541-345-4419
Mailing address:
  • Phone: 541-345-2800
  • Fax: 541-345-4419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberOR306
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: