Provider Demographics
NPI:1770571432
Name:CAMPBELL, MARK STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1450
Mailing Address - Country:US
Mailing Address - Phone:307-358-2122
Mailing Address - Fax:307-358-7347
Practice Address - Street 1:111 S 5TH ST STE 2
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:WY
Practice Address - Zip Code:82633-2434
Practice Address - Country:US
Practice Address - Phone:307-358-7365
Practice Address - Fax:307-358-7347
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO39321207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO50424203Medicaid
CO50424203Medicaid