Provider Demographics
NPI:1629640693
Name:STEPHANIE JULIET CAMPBELL, DO, LLC
Entity Type:Organization
Organization Name:STEPHANIE JULIET CAMPBELL, DO, LLC
Other - Org Name:CAMPBELL DERMATOLOGY AND AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-472-1405
Mailing Address - Street 1:706 NE EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3926
Mailing Address - Country:US
Mailing Address - Phone:503-472-1405
Mailing Address - Fax:503-434-5950
Practice Address - Street 1:706 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3926
Practice Address - Country:US
Practice Address - Phone:808-498-6617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-11
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty