Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 7238 | SC |
NPI | 1043317407 |
---|---|
Provider Name | Dr. Thomas William Campbell |
First Address | Greenville, SC 29605-4620 |
Second Address | Greenville, SC 29605-4620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D05602 | (02) | SC |