Provider Demographics
NPI:1780645051
Name:CAMPBELL, BRIAN DAVID (USN-IDC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:USN-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035C JOHN HANCOCK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-2405
Mailing Address - Country:US
Mailing Address - Phone:904-542-3500
Mailing Address - Fax:
Practice Address - Street 1:7400 SEWELLS POINT RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1756
Practice Address - Country:US
Practice Address - Phone:757-853-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman