Physician Compare National (NPI:1306012935)

HEALTHCARE PROVIDER: GOSPHA GORDON CAMPBELL M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1306012935
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062566847
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090812000888
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CAMPBELL
	Individual professional last name
Provider First Name	GOSPHA
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1850 S WATERMAN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE F
	Group Practice or individual's line 2 address
City	SAN BERNARDINO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	924082852
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y