Provider Demographics
NPI:1801872254
Name:CAMPBELL, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5501 DELMAR BLVD STE B560
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3084
Mailing Address - Country:US
Mailing Address - Phone:314-833-4030
Mailing Address - Fax:314-833-4031
Practice Address - Street 1:9417 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-2009
Practice Address - Country:US
Practice Address - Phone:314-833-4030
Practice Address - Fax:314-833-4031
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR1H15207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202499950Medicaid
MO202499950Medicaid
MO202499950Medicaid
3013298Medicare ID - Type Unspecified
MO203010753Medicare ID - Type UnspecifiedDOH