Provider Demographics
NPI:1730269853
Name:CAMPBELL, RICHARD M (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 LARIMER ST
Mailing Address - Street 2:STE 106
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202
Mailing Address - Country:US
Mailing Address - Phone:307-532-1804
Mailing Address - Fax:
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-378-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2890A207Q00000X
CO22404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82874069Medicaid
COCO306643Medicare PIN
WYW306999Medicare PIN
A73088Medicare UPIN
CO82874069Medicaid