Provider Demographics
NPI:1851717938
Name:WILLIAM R CAMPBELL DO PROF CORP
Entity Type:Organization
Organization Name:WILLIAM R CAMPBELL DO PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-491-1210
Mailing Address - Street 1:9 EQUESTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-2600
Mailing Address - Country:US
Mailing Address - Phone:415-609-9814
Mailing Address - Fax:
Practice Address - Street 1:1 DANIEL BURNHAM CT STE 365C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5490
Practice Address - Country:US
Practice Address - Phone:415-353-6400
Practice Address - Fax:415-353-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9718207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty