Individual
DEREK R CAMPBELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
765 S UTAH AVE, IDAHO FALLS, ID 83402-5093
(208) 525-2600
(208) 525-2611
Mailing address
765 S UTAH AVE, IDAHO FALLS, ID 83402-5093
(208) 525-2600
(208) 525-2611
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-344
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1302943
MEDICARE ID-PTAN
ID
05
—
806946200
—
ID
01
—
O-344
STATE LICENSE
ID
Enumeration date
07/19/2006
Last updated
01/25/2010
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