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:
Health care specialties
| Specialty | Code | License # | 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 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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