Provider Demographics
NPI:1710670773
Name:CAMPBELL, DURELL (AGENCY AFFILIATION)
Entity Type:Individual
Prefix:
First Name:DURELL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:AGENCY AFFILIATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9624 RENTON AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-5720
Mailing Address - Country:US
Mailing Address - Phone:206-581-4945
Mailing Address - Fax:
Practice Address - Street 1:216 JAMES ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-5102
Practice Address - Country:US
Practice Address - Phone:206-464-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61320661207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine