Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01043264 | IN |
NPI | 1023109345 |
---|---|
Provider Name | Mr. David A Campbell |
First Address | Fort Wayne, IN 46825-1545 |
Second Address | Fort Wayne, IN 46845-1713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 23/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000007472 | M PLAN (01) | |
000000184804 | ANTHEM (01) | |
000000636492 | ANTHEM (01) | IN |
100108770A | (05) | IN |
100466990 | (05) | IN |
4388517 | AETNA (01) | |
E83700 | (02) | |
P00782359 | R.R. MEDICARE (01) | IN |