MEDICARE: MR. JONATHAN CROSS CAMPBELL III 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	207Q00000X	Family Medicine Physician	15993	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00111807	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	051519758	OTHER	AL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1821065509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN CROSS CAMPBELL III MD

Provider Business Mailing Address
First Line	:	7505 MOFFETT RD
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36618-4193
Country	:	US
Telephone Number	:	251-649-6112
Fax Number	:	251-649-6115

Provider Business Practice Location Address
First Line	:	5320 HIGHWAY 90 W
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36619-4202
Country	:	US
Telephone Number	:	251-666-8232
Fax Number	:

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

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/11/2019

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