Provider Demographics
NPI:1982763470
Name:CAMPBELL, CHAD MICHAEL (PAC)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2375
Mailing Address - Street 2:
Mailing Address - City:CLAYPOOL
Mailing Address - State:AZ
Mailing Address - Zip Code:85532
Mailing Address - Country:US
Mailing Address - Phone:928-961-6892
Mailing Address - Fax:
Practice Address - Street 1:1100 N BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2757
Practice Address - Country:US
Practice Address - Phone:928-425-8200
Practice Address - Fax:928-425-8406
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1979363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMC0360951OtherDEA