Healthcare Provider Details

I. General information

NPI: 1073947719
Provider Name (Legal Business Name): TRAVIS CAMPBELL PHILIPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 S.W. SAM JACKSON PARK RD. OREGON HEALTH AND SCIENCE UNIVERSITY
PORTLAND OR
97239-3098
US

IV. Provider business mailing address

1314 NW IRVING ST APT 312
PORTLAND OR
97209-2723
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8311
  • Fax:
Mailing address:
  • Phone: 913-302-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD183450
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD183450
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: