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NPI Code Detail

MEDICARE: DR. MARK EDWARD CAMPBELL M.D.

MEDICARE: DR. MARK EDWARD CAMPBELL M.D.
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
1207RC0000XCardiovascular Disease Physician023324LA
2207RC0000XCardiovascular Disease Physician18362MS
3207RI0011XInterventional Cardiology Physician18362MS

Other Identifiers

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

General Provider Information

NPI Number : 1225090715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK EDWARD CAMPBELL M.D.
Provider Business Mailing Address
First Line : 2209 JEFFERSON DAVIS DR
Second Line :
City : OXFORD
State : MS
Zip : 38655-5221
Country : US
Telephone Number : 662-281-1115
Fax Number : 662-236-9401
Provider Business Practice Location Address
First Line : 2209 JEFFERSON DAVIS DR
Second Line :
City : OXFORD
State : MS
Zip : 38655-5221
Country : US
Telephone Number : 662-281-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 04/13/2020

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