Provider Demographics
NPI:1740279033
Name:CAMPBELL, JOHN KACHLER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KACHLER
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 ROYAL FORREST DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7651
Mailing Address - Country:US
Mailing Address - Phone:919-782-4894
Mailing Address - Fax:
Practice Address - Street 1:2910 ROYAL FORREST DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7651
Practice Address - Country:US
Practice Address - Phone:919-782-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63053207Q00000X
NC2010-01797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080116174OtherRR MEDICARE
FL375803600Medicaid
NC5916307Medicaid
NC5916307Medicaid
NCNC0213AMedicare PIN
FL080116174OtherRR MEDICARE