Basic Information
| Provider Information | |||||||||
| NPI: | 1023109345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 EAST DUPONT ROAD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603737875 | ||||||||
| FaxNumber: | 2603739705 | ||||||||
| Practice Location | |||||||||
| Address1: | 11141 PARKVIEW PLAZA DR | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2602668820 | ||||||||
| FaxNumber: | 2602668829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 01043264 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 000000184804 | 01 | ANTHEM | OTHER | 100108770A | 05 | IN | MEDICAID | 000000007472 | 01 | M PLAN | OTHER | 100466990 | 05 | IN | MEDICAID | 000000636492 | 01 | IN | ANTHEM | OTHER | 4388517 | 01 | AETNA | OTHER | P00782359 | 01 | IN | R.R. MEDICARE | OTHER |