Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 960047 | NC |
NPI | 1053331421 |
---|---|
Provider Name | James K. Campbell |
First Address | Gulfport, MS 39502-1810 |
Second Address | Gulfport, MS 39501-2404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 10/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1004L | BCBS (01) | NC |
891004L | (05) | NC |
G46082 | (02) |