Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 33535 | MO |
NPI | 1194902510 |
---|---|
Provider Name | Dr. Gary Hubert Campbell |
First Address | Chesterfield, MO 63017-3411 |
Second Address | Chesterfield, MO 63017-3411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2008 |
Last Update Date | 28/01/2008 |