Provider Demographics
NPI:1851488423
Name:CAMPBELL, MICHAEL JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACK
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12607 SE MILL PLAIN BLVD
Mailing Address - Street 2:NORTHWEST PERMANENTE, CASCADE PARK MEDICAL OFFICE
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:360-896-4460
Mailing Address - Fax:360-896-4478
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:NORTHWEST PERMANENTE, CASCADE PARK MEDICAL OFFICE
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-896-4460
Practice Address - Fax:360-896-4478
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-11-05
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Provider Licenses
StateLicense IDTaxonomies
WA416962084P0800X
ORMD217742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry