MEDICARE: DR. STUART BENJAMIN 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
1	207P00000X	Emergency Medicine Physician	G31978	CA
2	207R00000X	Internal Medicine Physician	G31978	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	:	1306842588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART BENJAMIN CAMPBELL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 821
Second Line	:
City	:	NEVADA CITY
State	:	CA
Zip	:	95959-0821
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 GLASSON WAY
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-5723
Country	:	US
Telephone Number	:	530-274-6085
Fax Number	:

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	08/07/2017

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