Provider Demographics
NPI:1114919347
Name:CAMPBELL, WILLIAM B (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105A RIDGECREST
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7807
Mailing Address - Country:US
Mailing Address - Phone:417-725-8250
Mailing Address - Fax:417-725-8253
Practice Address - Street 1:105A RIDGECREST
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-7807
Practice Address - Country:US
Practice Address - Phone:417-725-8250
Practice Address - Fax:417-725-8253
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2D18207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00174740OtherRR MEDICARE
MO241836204Medicaid
042050115Medicare ID - Type Unspecified
MO241836204Medicaid
MOMA1327027Medicare PIN