Provider Demographics
NPI:1740395474
Name:CAMPBELL, J WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:WILLIAM
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:222 S WOODS MILL RD
Mailing Address - Street 2:SUITE 750
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3625
Mailing Address - Country:US
Mailing Address - Phone:314-205-6600
Mailing Address - Fax:314-205-6172
Practice Address - Street 1:222 S WOODS MILL RD
Practice Address - Street 2:SUITE 750
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3625
Practice Address - Country:US
Practice Address - Phone:314-205-6600
Practice Address - Fax:314-205-6172
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9911207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
841682728OtherTAX ID
MO201604717Medicaid
P00246310OtherRR MEDICARE
MO201604717Medicaid
A12948Medicare UPIN
P00246310OtherRR MEDICARE