Provider Demographics
NPI:1407017387
Name:CAMPBELL, JERMAINE (DO)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:
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 1:12491 BAYWIND CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4704
Mailing Address - Country:US
Mailing Address - Phone:754-264-6061
Mailing Address - Fax:
Practice Address - Street 1:2701 N COURSE DR
Practice Address - Street 2:APT 125
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3030
Practice Address - Country:US
Practice Address - Phone:754-264-6061
Practice Address - Fax:844-321-1486
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS13774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program