Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 264348 | MA |
N | 207P00000X | Emergency Physician | DR.0060093 | CO |
Y | 207PE0004X | Emergency Medical Services | MD23589 | ME |
NPI | 1093100646 |
---|---|
Provider Name | Douglas D. Campbell |
First Address | Portland, ME 04102-3100 |
Second Address | Portland, ME 04102-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 15/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093100646 | (05) | ME |