Provider Demographics
NPI:1760470454
Name:CAMPBELL, MARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4190
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:2140 53RD AVE
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-6279
Practice Address - Country:US
Practice Address - Phone:563-421-5700
Practice Address - Fax:563-421-5709
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-04-30
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Provider Licenses
StateLicense IDTaxonomies
IA26139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06392OtherWELLMARK HEALTH PLAN
IA01N1OtherJOHN DEERE HEALTH PLAN
IA06392OtherWELLMARK HEALTH PLAN