Basic Information
| Provider Information | |||||||||
| NPI: | 1851717938 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAM R CAMPBELL DO PROF CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 EQUESTRIAN CT | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949452600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156099814 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 DANIEL BURNHAM CT STE 365C | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941095490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536400 | ||||||||
| FaxNumber: | 4153536401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2014 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | CAMPBELL | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4154911210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 20A9718 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.