=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750456026
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ALEXANDER CAMPBELL M.D., F.A.C.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 FLORENCE AVE
-----------------------------------------------------
City | GRANGER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46530-8048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-246-1000
-----------------------------------------------------
Fax | 574-246-4000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 51110 BRENSHIRE CT
-----------------------------------------------------
City | GRANGER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46530-9267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-271-9616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 01035158A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------