Provider Demographics
NPI:1225212962
Name:CAMPBELL, PETER JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
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:PO BOX 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3800
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:3200 E CAMELBACK RD
Practice Address - Street 2:STE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2311
Practice Address - Country:US
Practice Address - Phone:602-393-4263
Practice Address - Fax:602-393-2329
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24254207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3981OtherHEALTHNET
AZ359100Medicaid
AZZ136784Medicare PIN
AZP00845836Medicare PIN