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NPI Code Detail

MEDICARE: AVERY J. CAMPBELL M.D.

MEDICARE: AVERY J. 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
1390200000XStudent in an Organized Health Care Education/Training ProgramUT

General Provider Information

NPI Number : 1477496495
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY J. CAMPBELL M.D.
Provider Business Mailing Address
First Line : 30 N 1900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0002
Country : US
Telephone Number : 801-581-7899
Fax Number :
Provider Business Practice Location Address
First Line : 50 N MEDICAL DR
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84132-0001
Country : US
Telephone Number : 801-581-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2026
Last Update Date : 04/13/2026

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