Provider Demographics
NPI:1801844790
Name:CAMPBELL, W LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:LAWRENCE
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 1:1345 NW WALL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1972
Mailing Address - Country:US
Mailing Address - Phone:541-382-1395
Mailing Address - Fax:541-382-6576
Practice Address - Street 1:1345 NW WALL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1972
Practice Address - Country:US
Practice Address - Phone:541-382-1395
Practice Address - Fax:541-382-6576
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD263042084P0800X
TXE36612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR134169Medicare ID - Type Unspecified
I50180Medicare UPIN