Provider Demographics
NPI:1083692974
Name:CAMPBELL, WILLIAM DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:DAVID
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1 INDEPENDENCE PLZ STE 530
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2646
Mailing Address - Country:US
Mailing Address - Phone:205-445-0661
Mailing Address - Fax:205-445-0664
Practice Address - Street 1:1 INDEPENDENCE PLZ STE 530
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2646
Practice Address - Country:US
Practice Address - Phone:205-445-0661
Practice Address - Fax:205-445-0664
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1928213ES0103X
AL322213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA593578763OtherTAX ID NUMBER
FLU12361Medicare UPIN
FLK1092Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER N