Provider Demographics
NPI:1841493061
Name:CAMPBELL, WALTER A (AP)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 SW 163RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4952
Mailing Address - Country:US
Mailing Address - Phone:954-431-4352
Mailing Address - Fax:954-431-9225
Practice Address - Street 1:4913 SW 163RD AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4952
Practice Address - Country:US
Practice Address - Phone:954-431-4352
Practice Address - Fax:954-431-9225
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1499171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0926OtherBCBS PROVIDER NUMBER