Provider Demographics
NPI:1548377906
Name:CAMPBELL, STEPHEN D (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:D
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 1:318 S LINE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4606
Mailing Address - Country:US
Mailing Address - Phone:352-637-5678
Mailing Address - Fax:
Practice Address - Street 1:318 S LINE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4606
Practice Address - Country:US
Practice Address - Phone:352-637-5678
Practice Address - Fax:352-344-3569
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052185207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL04949OtherBCBS
FL047227100Medicaid
FL060014480OtherMEDICARE RAILROAD
59-2974057OtherTAX ID NUMBER
FL060014480OtherMEDICARE RAILROAD
59-2974057OtherTAX ID NUMBER