Provider Demographics
NPI:1043219066
Name:CAMPBELL, DOUGLAS MARTIN (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARTIN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-5225
Mailing Address - Country:US
Mailing Address - Phone:303-237-5401
Mailing Address - Fax:303-237-9638
Practice Address - Street 1:1861 WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5225
Practice Address - Country:US
Practice Address - Phone:303-237-5401
Practice Address - Fax:303-237-9638
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28726174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCA02292OtherBC/BS
CTAMISR5601OtherHMO CO
CO815434OtherAETNA HMO
CO01287267Medicaid
CO180007125OtherRR MEDICARE
CTAMISR5601OtherHMO CO
CO01287267Medicaid