Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 24254 | AZ |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 24254 | AZ |
NPI | 1225212962 |
---|---|
Provider Name | Peter John Campbell |
First Address | Phoenix, AZ 85038-9870 |
Second Address | Phoenix, AZ 85018-2311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 16/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
359100 | (05) | AZ |
3Z3981 | HEALTHNET (01) | AZ |