Provider Demographics
NPI:1952497810
Name:CAMPBELL, CLAY I (MD)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:I
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8299 MT HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-3583
Mailing Address - Country:US
Mailing Address - Phone:406-837-5541
Mailing Address - Fax:406-837-5543
Practice Address - Street 1:8299 MT HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3583
Practice Address - Country:US
Practice Address - Phone:406-837-5541
Practice Address - Fax:406-837-5543
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-6065207Q00000X
MT90015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110040800Medicaid
ID806820000Medicaid
ID002743700Medicaid