Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G77365 | CA |
N | 111NI0900X | Internist | G77365 | CA |
N | 208200000X | Surgeon | G77365 | CA |
N | 208600000X | Surgeon | G77365 | CA |
N | 2086S0102X | Surgical Critical Care | G77365 | CA |
NPI | 1306891064 |
---|---|
Provider Name | Andre Renay Campbell |
First Address | San Francisco, CA 94120-7464 |
Second Address | San Francisco, CA 94110-3518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G773650 | (05) | CA |
F67085 | (02) |