Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 125065467 | IL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 11268150-1205 | UT |
NPI | 1306251806 |
---|---|
Provider Name | Kevin Campbell |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 10/06/2019 |