Provider Demographics
NPI:1023108677
Name:CAMPBELL, WILLIAM T JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:2120 W KEARNEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1653
Practice Address - Country:US
Practice Address - Phone:417-869-6191
Practice Address - Fax:417-869-4131
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-05-30
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Provider Licenses
StateLicense IDTaxonomies
MO20060285972083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO# PENDINGMedicaid
MO# PENDINGMedicaid
MOC14113Medicare UPIN