Provider Demographics
NPI:1659331742
Name:CAMPBELL, KEITH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:E
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 1:431 MARILYN LN
Mailing Address - Street 2:
Mailing Address - City:ALCOA
Mailing Address - State:TN
Mailing Address - Zip Code:37701-2118
Mailing Address - Country:US
Mailing Address - Phone:865-233-5858
Mailing Address - Fax:865-233-5870
Practice Address - Street 1:431 MARILYN LN
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-2118
Practice Address - Country:US
Practice Address - Phone:865-233-5858
Practice Address - Fax:865-233-5870
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000379082086S0129X, 207Q00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00297886OtherMEIDCARE RAILROAD
TN4071369OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
G84475Medicare UPIN
TNP00297886OtherMEIDCARE RAILROAD