Provider Demographics
NPI:1821065509
Name:CAMPBELL, JONATHAN CROSS III (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:CROSS
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JONATHAN
Other - Middle Name:C
Other - Last Name:CAMPBELL
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7505 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-4193
Mailing Address - Country:US
Mailing Address - Phone:251-649-6112
Mailing Address - Fax:251-649-6115
Practice Address - Street 1:5320 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-4202
Practice Address - Country:US
Practice Address - Phone:251-666-8232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00111807OtherRAILROAD MEDICARE
AL051519758OtherBLUE CROSS BLUE SHIELD
AL051519758OtherBLUE CROSS BLUE SHIELD
E90656Medicare UPIN