Healthcare Provider Details

I. General information

NPI: 1780645051
Provider Name (Legal Business Name): BRIAN DAVID CAMPBELL USN-IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 SEWELLS POINT RD
NORFOLK VA
23513-1756
US

IV. Provider business mailing address

3035C JOHN HANCOCK CT
JACKSONVILLE FL
32221-2405
US

V. Phone/Fax

Practice location:
  • Phone: 757-853-0695
  • Fax:
Mailing address:
  • Phone: 904-542-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: