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Individual

C. E. CAMPBELL JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D., PA

Contact information

Practice address
609 FULTON ST, BLYTHEVILLE, AR 72315-1922
(870) 763-0855
(870) 763-0858
Mailing address
609 FULTON ST, BLYTHEVILLE, AR 72315-1922
(870) 763-0855
(870) 763-0858

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R1755
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
103439001
AR
01
1104017227
GROUP NPI
AR
01
1114934353
INDIVIDUAL NPI
AR
05
201045309
MO
01
50880
INDIVIDUAL BC/BS
AR
01
508807299
MEDICARE RENDERING #
AR
01
R1755
STATE LICENSE
AR
Enumeration date
08/01/2006
Last updated
03/01/2011
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