Provider Demographics
NPI:1265492011
Name:CAMPBELL, GARY E (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:E
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 20819
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-0819
Mailing Address - Country:US
Mailing Address - Phone:775-689-9117
Mailing Address - Fax:775-827-6715
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:#18
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6135
Practice Address - Country:US
Practice Address - Phone:775-823-1990
Practice Address - Fax:775-823-1974
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV54772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002016839Medicaid
C95852Medicare UPIN
NV002016839Medicaid