Healthcare Provider Details

I. General information

NPI: 1841288651
Provider Name (Legal Business Name): CRAIG JAMES CAMPBELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 S 4015 W SUITE 140
SALT LAKE CITY UT
84129-4258
US

IV. Provider business mailing address

5255 S 4015 W SUITE 140
SALT LAKE CITY UT
84129-4258
US

V. Phone/Fax

Practice location:
  • Phone: 801-969-1434
  • Fax: 801-969-1474
Mailing address:
  • Phone: 801-969-1434
  • Fax: 801-969-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number92-106790-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: