Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC180130 | CA |
Y | 213ER0200X | Radiology | DC180130 | CA |
NPI | 1164456901 |
---|---|
Provider Name | Dr. Dennis Lynn Campbell |
First Address | Wasco, CA 93280-1918 |
Second Address | Wasco, CA 93280-1918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 16/12/2019 |