Provider Demographics
NPI:1578655924
Name:CAMPBELL, GREGG SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:SCOTT
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 1:328 LINA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5467
Mailing Address - Country:US
Mailing Address - Phone:785-375-6931
Mailing Address - Fax:
Practice Address - Street 1:3850 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1502
Practice Address - Country:US
Practice Address - Phone:415-750-6052
Practice Address - Fax:415-750-1329
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100178730AMedicaid
KS100525OtherBCBS
KS100525OtherBCBS
KSG15687Medicare UPIN