Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0101046591 | VA |
N | 2086S0129X | Vascular Surgeon | 51819 | MT |
NPI | 1104880160 |
---|---|
Provider Name | Dr. Russell Witter Campbell |
First Address | Newport News, VA 23601-1318 |
Second Address | Williamsburg, VA 23188-3409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104880160 | (05) | VA |
C90685 | (02) | VA |