Provider Demographics
NPI:1659431583
Name:CAMPBELL, ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E. ALTAMONTE DR STE 205
Mailing Address - Street 2:STE #205
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4810
Mailing Address - Country:US
Mailing Address - Phone:407-813-2413
Mailing Address - Fax:407-792-1019
Practice Address - Street 1:616 E ALTAMONTE DR STE 205
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4810
Practice Address - Country:US
Practice Address - Phone:407-813-2413
Practice Address - Fax:407-792-1019
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4541213E00000X, 213EP0504X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123656300Medicaid
NYDMERCOther4774560002
NYP386760OtherOXFORD
NYDMERCOther4774560001
NYP04660-8OtherWORKERS' COMPENSATION
NY01276420Medicaid
NY134179985OtherTAX IDENTIFICATION NUMBER
NYPH239OtherEMPIRE BC BS
P53961Medicare ID - Type Unspecified
NYPH239OtherEMPIRE BC BS