Provider Demographics
NPI:1679717599
Name:CAMPBELL, KEITH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62626 SPARROW HAWK CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6788
Mailing Address - Country:US
Mailing Address - Phone:541-678-5063
Mailing Address - Fax:
Practice Address - Street 1:62626 SPARROW HAWK CIR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6788
Practice Address - Country:US
Practice Address - Phone:541-678-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG068971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine