Provider Demographics
NPI:1215953310
Name:CAMPBELL, ROBERT S (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1912
Mailing Address - Country:US
Mailing Address - Phone:303-584-8231
Mailing Address - Fax:866-210-0907
Practice Address - Street 1:12207 PECOS ST
Practice Address - Street 2:#300
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3400
Practice Address - Country:US
Practice Address - Phone:303-650-0445
Practice Address - Fax:303-429-5088
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2010-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO46363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811604OtherMEDICARE GROUP NUMBER
CO011500OtherKAISER COMMERCIAL NUMBER
CO348308OtherMEDICARE GROUP PTAN
CO98579274Medicaid
CO98579274Medicaid
CO348308OtherMEDICARE GROUP PTAN
COC811664Medicare PIN
CO011500OtherKAISER COMMERCIAL NUMBER
COCO306919Medicare PIN