Provider Demographics
NPI:1245336577
Name:CAMPBELL, JASON F (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:F
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 POPLAR ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462-1235
Mailing Address - Country:US
Mailing Address - Phone:207-723-3003
Mailing Address - Fax:207-723-3006
Practice Address - Street 1:165 POPLAR ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462-1235
Practice Address - Country:US
Practice Address - Phone:207-723-3003
Practice Address - Fax:207-723-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME12906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME121510099Medicaid
ME001022OtherANTHEM
ME5153206OtherAETNA
MEMN4020OtherHARVARD PILGRIM
ME001022OtherANTHEM
MECAMM2915Medicare ID - Type Unspecified