Provider Demographics
NPI:1104091677
Name:NEIL A CAMPBELL DPM PA
Entity type:Organization
Organization Name:NEIL A CAMPBELL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-741-3668
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-0762
Mailing Address - Country:US
Mailing Address - Phone:361-741-3668
Mailing Address - Fax:361-293-7058
Practice Address - Street 1:1200 CARL RAMERT DR
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-4868
Practice Address - Country:US
Practice Address - Phone:361-741-3668
Practice Address - Fax:361-293-7058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU56972Medicare UPIN
TX4579730001Medicare NSC
TX00314PMedicare PIN