Provider Demographics
NPI:1528503257
Name:HOUSTON MALE HEALTH CLINIC, PLLC
Entity type:Organization
Organization Name:HOUSTON MALE HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENR / DIRECTOR / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-506-2610
Mailing Address - Street 1:12221 MERIT DR
Mailing Address - Street 2:SUITE 620
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 DURHAM DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2271
Practice Address - Country:US
Practice Address - Phone:214-506-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty