Provider Demographics
NPI:1053373415
Name:CAMPBELL, JOHN THOMAS II (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:CAMPBELL
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:4386 TRAIL BOSS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7512
Mailing Address - Country:US
Mailing Address - Phone:303-688-8666
Mailing Address - Fax:303-688-8260
Practice Address - Street 1:4386 TRAIL BOSS DR
Practice Address - Street 2:SUITE A
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7512
Practice Address - Country:US
Practice Address - Phone:303-688-8666
Practice Address - Fax:303-688-8260
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-01-29
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Provider Licenses
StateLicense IDTaxonomies
CO40745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56176571Medicaid
CO56176571Medicaid