Provider Demographics
NPI:1174503254
Name:CAMPBELL, CAM F (MD)
Entity Type:Individual
Prefix:
First Name:CAM
Middle Name:F
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 1:788 8TH AVE SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401
Mailing Address - Country:US
Mailing Address - Phone:319-832-2328
Mailing Address - Fax:319-832-1168
Practice Address - Street 1:788 8TH AVE SE
Practice Address - Street 2:SUITE 400
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2119
Practice Address - Country:US
Practice Address - Phone:319-832-2328
Practice Address - Fax:319-832-1168
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23830207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3899OtherRR MEDICARE GROUP
03081OtherWELLMARK
IA0252817Medicaid
110042250OtherRR MEDICARE
71960OtherMEDICARE GROUP
P00741046OtherRR MEDICARE
03081Medicare PIN
CA3899OtherRR MEDICARE GROUP