Provider Demographics
NPI:1861505679
Name:CAMPBELL, EVERETT LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3800 N. MESA STE A-2
Mailing Address - Street 2:#353
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-856-3900
Mailing Address - Fax:915-856-3904
Practice Address - Street 1:3800 N. MESA STE A-2
Practice Address - Street 2:#353
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-856-3900
Practice Address - Fax:915-856-3904
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH3001207X00000X
NM75-14207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH3001OtherTX MEDICAL LICENSE
TXD35548Medicare UPIN