Provider Demographics
NPI:1194287482
Name:CAMPBELL, GRAHAM (MD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
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:PO BOX 55050
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72215-5050
Mailing Address - Country:US
Mailing Address - Phone:501-906-3000
Mailing Address - Fax:501-907-6522
Practice Address - Street 1:2605 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6133
Practice Address - Country:US
Practice Address - Phone:501-906-3000
Practice Address - Fax:501-907-6522
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI760752085R0001X, 208D00000X
390200000X
ARE-178242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program