Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 68-31 | NM |
NPI | 1003887829 |
---|---|
Provider Name | Philip Kamps |
First Address | Gallup, NM 87301-5683 |
Second Address | Gallup, NM 87301-5682 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10002102 | LOVELACE HEALTH/SALUD (01) | NM |
14589 | (05) | NM |
228686 | (05) | AZ |
85031326887301A132 | CHAMPUS (01) | |
D43190 | (02) | |
NM001458 | BC/BS (01) | NM |