Provider Demographics
NPI:1922334317
Name:CRAIG J CAMPBELL DPM PC
Entity Type:Organization
Organization Name:CRAIG J CAMPBELL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:801-969-1434
Mailing Address - Street 1:5255 S 4015 W
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4258
Mailing Address - Country:US
Mailing Address - Phone:801-969-1434
Mailing Address - Fax:801-969-1474
Practice Address - Street 1:5255 S 4015 W
Practice Address - Street 2:SUITE 140
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84129-4258
Practice Address - Country:US
Practice Address - Phone:801-969-1434
Practice Address - Fax:801-969-1474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric