Provider Demographics
NPI:1417972860
Name:CAMPBELL, ROBERT COULTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COULTER
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 1:177 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2429
Mailing Address - Country:US
Mailing Address - Phone:336-835-3400
Mailing Address - Fax:336-835-3664
Practice Address - Street 1:177 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2429
Practice Address - Country:US
Practice Address - Phone:336-835-3400
Practice Address - Fax:336-835-3664
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127NKMedicaid
2280741Medicare ID - Type Unspecified
NC89127NKMedicaid