Provider Demographics
NPI:1033108642
Name:CAMPBELL, AMY O (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:O
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:OCONOR
Other - Last Name:MAIOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2575 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-3806
Mailing Address - Country:US
Mailing Address - Phone:303-449-3594
Mailing Address - Fax:303-447-0462
Practice Address - Street 1:2880 FOLSOM ST STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3769
Practice Address - Country:US
Practice Address - Phone:303-327-7047
Practice Address - Fax:303-443-7168
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I14350Medicare UPIN
546058Medicare ID - Type Unspecified