Provider Demographics
NPI:1861482887
Name:CAMPBELL, ERIC J (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E BASELINE RD STE 425
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0049
Mailing Address - Country:US
Mailing Address - Phone:405-260-8605
Mailing Address - Fax:405-369-9310
Practice Address - Street 1:17937 N PENNSYLVANIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-9001
Practice Address - Country:US
Practice Address - Phone:405-260-8605
Practice Address - Fax:405-369-9310
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100138410BMedicaid
244419704Medicare ID - Type Unspecified
S40562Medicare UPIN