Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A62134 | CA |
NPI | 1083792774 |
---|---|
Provider Name | Richard J. Campbell |
First Address | Oakland, CA 94612-3466 |
Second Address | Sacramento, CA 95825-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A621340 | (05) | CA |
H50683 | (02) |