Provider Demographics
NPI:1780611426
Name:CAMPBELL, WILLIAM ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:258 BARRETT CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5302
Mailing Address - Country:US
Mailing Address - Phone:888-491-1210
Mailing Address - Fax:888-849-4257
Practice Address - Street 1:1 DANIEL BURNHAM CT
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-409-7364
Practice Address - Fax:415-409-0735
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9718207X00000X, 207XS0117X
CO43894207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I3483Medicare UPIN