Provider Demographics
NPI:1770527343
Name:CAMPBELL, WILLIAM RICHARD JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:R
Other - Last Name:CAMPBELL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12327 EL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2223
Mailing Address - Country:US
Mailing Address - Phone:913-469-4325
Mailing Address - Fax:913-469-4325
Practice Address - Street 1:12327 EL MONTE ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209-2223
Practice Address - Country:US
Practice Address - Phone:913-469-4325
Practice Address - Fax:913-469-4325
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20248208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69273Medicare UPIN
KSK956865AMedicare PIN
MOK956865Medicare PIN