1902284136 NPI number — DAMIAN CAMPBELL DO

Table of content: DAMIAN CAMPBELL DO (NPI 1902284136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902284136 NPI number — DAMIAN CAMPBELL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
DAMIAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902284136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733784
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-3784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-885-6483
Provider Business Mailing Address Fax Number:
682-885-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4200 W UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75078-9805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-303-4200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  S6144 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)