MEDICARE: DR. CRAIG JAMES CAMPBELL D.P.M.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	92-106790-0501	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	270015335	OTHER	UT	T.I.N.

General Provider Information

NPI Number	:	1841288651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG JAMES CAMPBELL D.P.M.

Provider Business Mailing Address
First Line	:	5255 S 4015 W
Second Line	:	SUITE 140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-4258
Country	:	US
Telephone Number	:	801-969-1434
Fax Number	:	801-969-1474

Provider Business Practice Location Address
First Line	:	5255 S 4015 W
Second Line	:	SUITE 140
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84129-4258
Country	:	US
Telephone Number	:	801-969-1434
Fax Number	:	801-969-1474

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	05/01/2012

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