Provider Demographics
NPI:1841288651
Name:CAMPBELL, CRAIG JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:JAMES
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 S 4015 W
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4258
Mailing Address - Country:US
Mailing Address - Phone:801-969-1434
Mailing Address - Fax:801-969-1474
Practice Address - Street 1:5255 S 4015 W
Practice Address - Street 2:SUITE 140
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84129-4258
Practice Address - Country:US
Practice Address - Phone:801-969-1434
Practice Address - Fax:801-969-1474
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT92-106790-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT270015335OtherT.I.N.
UT270015335OtherT.I.N.
UT4595570001Medicare NSC
UT000012604Medicare ID - Type Unspecified