Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0102204037 | VA |
NPI | 1003255936 |
---|---|
Provider Name | Dr. Paul Charles Campbell |
First Address | San Diego, CA 92134-1098 |
Second Address | San Diego, CA 92134-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 21/04/2017 |