Campbell, Gregory Lee

Campbell, Gregory Lee is an individual health care provider with primary practice located at 6824 Newburg Rd , Rockford IL 61108. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Campbell, Gregory Lee can be contacted via phone (779) 696-7610.

Contact Information

Primary practice address
6824 Newburg Rd Rockford IL 61108
Phone: (779) 696-7610
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0085001724 Illinois

Profile Details

NPI number 1508849480
LBN Legal business name Campbell, Gregory Lee
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 23rd, 2005
Last updated Feb 18th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508849480 NPPES
Illinois MEDICAID 0085001724

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