Provider Demographics
NPI:1083735070
Name:CAMPBELL, MATTHEW PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 S AKERS ST
Mailing Address - Street 2:STE 120
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8306
Mailing Address - Country:US
Mailing Address - Phone:559-625-4118
Mailing Address - Fax:559-625-6004
Practice Address - Street 1:820 S AKERS ST STE 120
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8306
Practice Address - Country:US
Practice Address - Phone:559-625-4118
Practice Address - Fax:559-625-6004
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA722342086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72234OtherMEDICAL LICENSE
CA00A722340OtherBLUE SHIELD OF CALIFORNIA
CAP00228921OtherRAILROAD MEDICARE
CA00A722340Medicaid
CAG07309Medicare UPIN