Provider Demographics
NPI:1609882968
Name:CAMPBELL, WILLIAM S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:CAMPBELL
Suffix:JR
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 1:527 N PALO ALTO AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3639
Mailing Address - Country:US
Mailing Address - Phone:850-747-4905
Mailing Address - Fax:850-747-4907
Practice Address - Street 1:527 N PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3639
Practice Address - Country:US
Practice Address - Phone:850-747-4905
Practice Address - Fax:850-747-4907
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J432085R0202X
FLME516892085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277988900Medicaid
063896OtherHEALTH ALLIANCE
AR143789001Medicaid
430954380CAPOtherMERCY HEALTH PLAN
IL036-068623OtherIL BLUE CROSS BLUE SHIELD
FL95529OtherBCBS
MO202664801Medicaid
254725OtherHEALTHLINK
MO185214OtherMO BLUE CROSS BLUE SHIELD
IL036-068623OtherIL BLUE CROSS BLUE SHIELD
MO185214OtherMO BLUE CROSS BLUE SHIELD
254725OtherHEALTHLINK
063896OtherHEALTH ALLIANCE
MO202664801Medicaid
AR143789001Medicaid
IL300128841Medicare ID - Type UnspecifiedIL RAILROAD MEDICARE
FLAE269XMedicare PIN