Provider Demographics
NPI:1457339988
Name:CAMPBELL, MARK F (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:F
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:MARK
Other - Middle Name:F
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1390 S WINCHESTER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4304
Mailing Address - Country:US
Mailing Address - Phone:408-866-8200
Mailing Address - Fax:408-378-2007
Practice Address - Street 1:1390 S WINCHESTER BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4304
Practice Address - Country:US
Practice Address - Phone:408-866-8200
Practice Address - Fax:408-378-2007
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG296480173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44099Medicare UPIN