Basic Information
Provider Information
NPI: 1932185212
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CAMPBELL
FirstName: JAMES
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: LOCKBOX # 17, 2424 EAST 21ST STREET
Address2: SUITE 100
City: TULSA
State: OK
PostalCode: 741141711
CountryCode: US
TelephoneNumber: 8663218433
FaxNumber:  
Practice Location
Address1: 300 ROCKEFELLER DR
Address2:  
City: MUSKOGEE
State: OK
PostalCode: 744015075
CountryCode: US
TelephoneNumber: 9187819466
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/19/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207PE0004X3180OKY Allopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services

No ID Information.


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