Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 005357 | AZ |
NPI | 1003846957 |
---|---|
Provider Name | Dr. Robert Campbell |
First Address | Prescott, AZ 86305-9032 |
Second Address | Prescott, AZ 86301-1641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 30/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I16415 | (02) |