Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ML60959479 | WA |
Y | 208600000X | Surgeon | ML60959479 | WA |
NPI | 1013478270 |
---|---|
Provider Name | John Campbell |
First Address | Seattle, WA 98122 |
Second Address | Seattle, WA 98122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2019 |
Last Update Date | 19/06/2019 |