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General NPI Number Information
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NPI Number | 1215182803
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Entity Type | Organization
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Legal Business Name | GOSPHA G, CAMPBELL MD INC
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 02/15/2012
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Provider Practice Location Address
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Address Line | 1850 S WATERMAN AVE # F
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2877
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Country | US
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Telephone | 909-890-9393
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Fax | 909-890-9394
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Provider Business Mailing Address
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Address Line | 1850 S WATERMAN AVE, # F
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-2464
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Country | US
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Telephone | 909-890-9393
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Fax | 909-890-9394
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GOSPHA G CAMPBELL
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Credential | MD
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Telephone | 909-890-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | A 102029
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License Number State | CA
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