MEDICARE: DR. DAVID PAUL CAMPBELL D.O.

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	207Q00000X	Family Medicine Physician	1711	OK

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	:	1073570792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID PAUL CAMPBELL D.O.

Provider Business Mailing Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE C
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-7147
Fax Number	:	918-838-2434

Provider Business Practice Location Address
First Line	:	8523 E 11TH ST
Second Line	:	SUITE C
City	:	TULSA
State	:	OK
Zip	:	74112-7963
Country	:	US
Telephone Number	:	918-836-7147
Fax Number	:	918-838-2434

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	02/17/2010

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