Provider Demographics
NPI:1720091077
Name:CAMPBELL, JAMES R (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:510 N ELM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-2539
Mailing Address - Country:US
Mailing Address - Phone:918-251-1391
Mailing Address - Fax:918-251-3008
Practice Address - Street 1:510 N ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-2539
Practice Address - Country:US
Practice Address - Phone:918-251-1391
Practice Address - Fax:918-251-3008
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731328479OtherTAX IDENTIFICATION NUMBER
OK1880OtherSTATE LICENSE NUMBER
OK731328479OtherTAX IDENTIFICATION NUMBER
OKE45393Medicare UPIN