Individual
MR. GREGORY LEE CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6824 NEWBURG RD, ROCKFORD, IL 61108
(779) 696-7610
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0085001724
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0085001724
—
IL
Enumeration date
11/23/2005
Last updated
02/18/2021
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