Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A72234 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | A72234 | CA |
NPI | 1083735070 |
---|---|
Provider Name | Dr. Matthew Peter Campbell |
First Address | Visalia, CA 93277-8306 |
Second Address | Visalia, CA 93277-8306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 02/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A72234 | MEDICAL LICENSE (01) | CA |
G07309 | (02) | CA |