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Individual
JOSEPH CAMPBELL
Active
Individual
JOSEPH CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NULL
390200000X
Student in an Organized Health Care Education/Training Program
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2068745
—
WA
01
—
PA-1748
STATE OF IDAHO BOARD OF MEDICINE
ID
Enumeration date
08/17/2015
Last updated
07/02/2019
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