Provider Demographics
NPI:1346306743
Name:CAMPBELL, VELMA L (MD)
Entity type:Individual
Prefix:
First Name:VELMA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
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 4244
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-0244
Mailing Address - Country:US
Mailing Address - Phone:719-542-1615
Mailing Address - Fax:719-561-1149
Practice Address - Street 1:517 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2075
Practice Address - Country:US
Practice Address - Phone:719-542-1615
Practice Address - Fax:719-561-1149
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28595207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1285956Medicaid
CO1285956Medicaid
COB62509Medicare UPIN