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General NPI Number Information
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NPI Number | 1295813475
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Entity Type | Organization
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Legal Business Name | CLAY I. CAMPBELL M.D.,P.C.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 166 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-3847
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Fax | 208-847-1620
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Provider Business Mailing Address
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Address Line | 166 S 5TH ST
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-3847
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Fax | 208-847-1620
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Authorized Official
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Title or Position | OWNER
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Name | CLAY I CAMPBELL
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Credential | M.D.
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Telephone | 208-847-3847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-6056
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License Number State | ID
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