MEDICARE: CRAIG ALAN CAMPBELL 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	207X00000X	Orthopaedic Surgery Physician	G13487	CA

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	:	1205820412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG ALAN CAMPBELL MD

Provider Business Mailing Address
First Line	:	555 PETALUMA AVE
Second Line	:	STE B
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4224
Country	:	US
Telephone Number	:	707-823-7602
Fax Number	:	707-823-7625

Provider Business Practice Location Address
First Line	:	555 PETALUMA AVE
Second Line	:	STE B
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4224
Country	:	US
Telephone Number	:	707-823-7602
Fax Number	:	707-823-7625

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	01/31/2008

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