Provider Demographics
NPI:1730175910
Name:CAMPBELL, MARK RUE (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:RUE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 990
Mailing Address - Street 2:102 W 18TH STREET
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-0990
Mailing Address - Country:US
Mailing Address - Phone:270-466-9300
Mailing Address - Fax:270-466-3300
Practice Address - Street 1:120 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:KY
Practice Address - Zip Code:42286-9734
Practice Address - Country:US
Practice Address - Phone:270-466-9300
Practice Address - Fax:270-466-3300
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2020-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY22075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64220759Medicaid
C67366Medicare UPIN
KY0784901Medicare PIN