MEDICARE: DR. WILLIAM T. CAMPBELL JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician	2006028597	MO
2	207Q00000X	Family Medicine Physician	2006028597	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023108677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM T. CAMPBELL JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 2580
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65801-2580
Country	:	US
Telephone Number	:	417-829-4620
Fax Number	:	417-829-4316

Provider Business Practice Location Address
First Line	:	2120 W KEARNEY ST
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-1653
Country	:	US
Telephone Number	:	417-869-6191
Fax Number	:	417-869-4131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/30/2008

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