Individual
JESSE R. CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1575 N SANTA FE AVE, EDMOND, OK 73003-3638
(405) 285-0660
(405) 285-0659
Mailing address
4401 W MEMORIAL RD, SUITE 140, OKLAHOMA CITY, OK 73134-1785
(405) 755-1515
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20229
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108140A
—
OK
01
—
20229
LICENSE
OK
01
—
25208
OBNDD
OK
Enumeration date
05/09/2006
Last updated
12/28/2017
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