Provider Demographics
NPI:1568411817
Name:CLINE-CAMPBELL, DOROTHY (DO)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:CLINE-CAMPBELL
Suffix:
Gender:F
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-0067
Mailing Address - Country:US
Mailing Address - Phone:641-664-3621
Mailing Address - Fax:641-664-3690
Practice Address - Street 1:607 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1516
Practice Address - Country:US
Practice Address - Phone:641-664-3621
Practice Address - Fax:641-664-3690
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3085316Medicaid
IA3085316Medicaid
I3146Medicare ID - Type Unspecified