Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2007025194 | MO |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | C168949 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD041355 | DC |
NPI | 1346450970 |
---|---|
Provider Name | Dr. John Campbell |
First Address | Santa Maria, CA 93454-4890 |
Second Address | Santa Maria, CA 93454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 24/06/2021 |