Provider Demographics
NPI:1811017999
Name:CAMPBELL, CHAD ERVIN (DO)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ERVIN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8108
Mailing Address - Country:US
Mailing Address - Phone:407-792-1144
Mailing Address - Fax:407-232-9807
Practice Address - Street 1:690 S GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8108
Practice Address - Country:US
Practice Address - Phone:407-792-1144
Practice Address - Fax:407-232-9807
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005242207R00000X, 208000000X
FLOS16049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE