Healthcare Provider Details

I. General information

NPI: 1093866378
Provider Name (Legal Business Name): PAUL DRAPER CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CALIFORNIA AVE STE 216
WAHIAWA HI
96786-1841
US

IV. Provider business mailing address

PO BOX 861026
WAHIAWA HI
96786-1026
US

V. Phone/Fax

Practice location:
  • Phone: 808-722-9503
  • Fax:
Mailing address:
  • Phone: 808-722-9503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA-165
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: