Provider Demographics
NPI:1548351463
Name:CAMPBELL, DOYLE RAY (MD)
Entity type:Individual
Prefix:
First Name:DOYLE
Middle Name:RAY
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 1:201 NW 70TH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2369
Mailing Address - Country:US
Mailing Address - Phone:954-693-9133
Mailing Address - Fax:954-641-1451
Practice Address - Street 1:201 NW 70TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2369
Practice Address - Country:US
Practice Address - Phone:954-693-9133
Practice Address - Fax:954-641-1451
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME19220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71731Medicare PIN