Provider Demographics
NPI:1477963163
Name:CAMPBELL, TIFFANY A (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SOUTH JACKSON ST.
Mailing Address - Street 2:#C1H17
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-5689
Mailing Address - Fax:502-852-4701
Practice Address - Street 1:530 SOUTH JACKSON ST.
Practice Address - Street 2:#C1H17
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5689
Practice Address - Fax:502-852-4701
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3448207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine