Provider Demographics
NPI:1609240613
Name:CAMPBELL, BENJAMIN C (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
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 1:6007 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4801
Mailing Address - Country:US
Mailing Address - Phone:480-833-3698
Mailing Address - Fax:480-833-3755
Practice Address - Street 1:6007 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4801
Practice Address - Country:US
Practice Address - Phone:480-833-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-15
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147542207W00000X
IN01082001A207W00000X, 207WX0200X
AZ62162207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology