Provider Demographics
NPI:1790765089
Name:CAMPBELL, JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAKEVIEW RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3475
Mailing Address - Country:US
Mailing Address - Phone:727-442-4178
Mailing Address - Fax:727-442-2390
Practice Address - Street 1:1000 LAKEVIEW RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3475
Practice Address - Country:US
Practice Address - Phone:813-890-8004
Practice Address - Fax:813-290-9691
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036817200Medicaid
FLD67258Medicare UPIN
FL79124Medicare ID - Type Unspecified