Campbell, Derek R

Campbell, Derek R is an individual health care provider with primary practice located at 765 S Utah Ave , Idaho Falls ID 83402-5093. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Campbell, Derek R can be contacted via phone (208) 525-2600.

Contact Information

Primary practice address
765 S Utah Ave Idaho Falls ID 83402-5093
Phone: (208) 525-2600
Fax: (208) 525-2611
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X O-344 Idaho

Profile Details

NPI number 1306865464
LBN Legal business name Campbell, Derek R
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Jan 25th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306865464 NPPES
Idaho Other 1302943 MEDICARE ID-PTAN
Idaho Other O-344 MEDICARE ID-PTAN
Idaho MEDICAID 806946200 MEDICARE ID-PTAN

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