Provider Demographics
NPI:1336192582
Name:CAMPBELL, RODGER S (MD)
Entity type:Individual
Prefix:
First Name:RODGER
Middle Name:S
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 1:106 WEST BLAIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785
Mailing Address - Country:US
Mailing Address - Phone:417-276-5620
Mailing Address - Fax:
Practice Address - Street 1:106 WEST BLAIR DRIVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785
Practice Address - Country:US
Practice Address - Phone:417-276-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105976208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105976OtherMISSOURI MEDICAL LICENSE