Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 38308 | NC |
NPI | 1710974332 |
---|---|
Provider Name | Jeffrey Paul Campbell |
First Address | Lumberton, NC 28359-1246 |
Second Address | Lumberton, NC 28358-2324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20932 | BCBSNC (01) | NC |
7920932 | (05) | NC |
E35859 | (02) |