Provider Demographics
NPI:1386741833
Name:CAMPBELL, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
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 1:5505 E PIONEER FORK RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1682
Mailing Address - Country:US
Mailing Address - Phone:801-582-4313
Mailing Address - Fax:801-583-4206
Practice Address - Street 1:1060 E 100 S
Practice Address - Street 2:STE 109
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1501
Practice Address - Country:US
Practice Address - Phone:801-328-4662
Practice Address - Fax:801-328-9166
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT180990-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063106Medicare PIN
UTA29160Medicare UPIN