Healthcare Provider Details

I. General information

NPI: 1962962407
Provider Name (Legal Business Name): CRAIG J CAMPBELL DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 S 4015 W #140
SALT LAKE CITY UT
84129
US

IV. Provider business mailing address

5255 S 4015 W #140
SALT LAKE CITY UT
84129
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-1434
  • Fax:
Mailing address:
  • Phone: 801-969-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CRAIG CAMPBELL
Title or Position: OWNER
Credential:
Phone: 801-969-1434