Provider Demographics
NPI:1427131135
Name:CAMPBELL, DANIEL J (DPM)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 COMMERCIAL ST SE
Mailing Address - Street 2:STE 201
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4495
Mailing Address - Country:US
Mailing Address - Phone:503-378-1162
Mailing Address - Fax:503-540-3105
Practice Address - Street 1:2720 COMMERCIAL ST SE
Practice Address - Street 2:STE 201
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4495
Practice Address - Country:US
Practice Address - Phone:503-378-1162
Practice Address - Fax:503-540-3105
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR97213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR032466Medicaid
OR032466Medicaid
C000SGBCLMedicare ID - Type Unspecified