Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 23427 | CA |
N | 111NI0013X | Independent Medical Examiner | 23427 | CA |
N | 111NI0013X | Independent Medical Examiner | 950433 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 23427 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 3391 | CA |
NPI | 1962615633 |
---|---|
Provider Name | H Edward Camp |
First Address | San Francisco, CA 94121 |
Second Address | San Francisco, CA 94118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
915751 | QUALIFIED MEDICAL EVALUAT (01) | CA |
U57370 | (02) | CA |