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General NPI Number Information
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NPI Number | 1972566727
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Entity Type | Individual
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Provider Name | RALPH P CAMPANALE II M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 180 W FIRST STREET SUITE 301
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City | KETCHUM
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State | ID
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Zip | 83340
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Country | US
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Telephone | 208-726-3707
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Fax | 208-726-4817
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Provider Business Mailing Address
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Address Line | PO BOX 777
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City | COEUR D ALENE
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State | ID
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Zip | 83816-0777
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Country | US
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Telephone | 208-772-5882
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Fax | 208-762-7543
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M4961
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License Number State | ID
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