Healthcare Provider Details

I. General information

NPI: 1114996675
Provider Name (Legal Business Name): CHRIS FRANK CAMPANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E 4500 S STE 4
SALT LAKE CITY UT
84107-4297
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-0055
  • Fax: 801-266-0056
Mailing address:
  • Phone: 843-284-3400
  • Fax: 843-284-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number187346-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number187346-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: