Provider Demographics
NPI:1063405629
Name:CAMPBELL, JAMES EARNEST (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EARNEST
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 W BELL RD.
Mailing Address - Street 2:STE C-122 #602
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-439-2400
Mailing Address - Fax:602-439-1414
Practice Address - Street 1:4747 W COUNTRY GABLES DR.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-439-2400
Practice Address - Fax:602-439-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54582084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5458OtherMEDICAL LICENSE
AC4680686OtherDEA NO
D43763Medicare UPIN
23346Medicare ID - Type Unspecified