Provider Demographics
NPI:1922187285
Name:CAMPBELL, WALTER PHILIP
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:PHILIP
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 NW 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5239
Mailing Address - Country:US
Mailing Address - Phone:954-242-0465
Mailing Address - Fax:
Practice Address - Street 1:2692 N UNIVERSITY DR
Practice Address - Street 2:SUITE 10
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-2496
Practice Address - Country:US
Practice Address - Phone:954-749-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1360332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5191330001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER