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General NPI Number Information
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NPI Number | 1144362146
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Entity Type | Organization
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Legal Business Name | BRUCE D CAMPBELL MD, LLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 4303 FREE UNION ROAD
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City | FREE UNION
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State | VA
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Zip | 22940
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Country | US
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Telephone | 434-978-1691
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | FREE UNION
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State | VA
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Zip | 22940-0220
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Country | US
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Telephone | 434-978-1691
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BRUCE DONALD CAMPBELL JR.
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Credential | MD
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Telephone | 434-978-1691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101035228
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License Number State | VA
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