Provider Demographics
NPI:1609882968
Name:CAMPBELL, WILLIAM S JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:CAMPBELL
Suffix:JR
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 1:609 N BAY DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-3026
Mailing Address - Country:US
Mailing Address - Phone:503-813-8478
Mailing Address - Fax:
Practice Address - Street 1:609 N BAY DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3026
Practice Address - Country:US
Practice Address - Phone:503-813-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1J432085R0202X
FLME516892085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
063896OtherHEALTH ALLIANCE
430954380CAPOtherMERCY HEALTH PLAN
FL95529OtherBCBS
IL036-068623OtherIL BLUE CROSS BLUE SHIELD
AR143789001Medicaid
MO202664801Medicaid
FL277988900Medicaid
MO185214OtherMO BLUE CROSS BLUE SHIELD
254725OtherHEALTHLINK
IL036-068623OtherIL BLUE CROSS BLUE SHIELD
MO185214OtherMO BLUE CROSS BLUE SHIELD
254725OtherHEALTHLINK
063896OtherHEALTH ALLIANCE
MO202664801Medicaid
AR143789001Medicaid
IL300128841Medicare ID - Type UnspecifiedIL RAILROAD MEDICARE
FLAE269XMedicare PIN