Provider Demographics
NPI:1891762142
Name:CAMPBELL, RICHARD G (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13722 EMBASSY ROW
Mailing Address - Street 2:TEXAS MEDCLINIC
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2000
Mailing Address - Country:US
Mailing Address - Phone:210-349-5577
Mailing Address - Fax:210-491-2843
Practice Address - Street 1:13722 EMBASSY ROW
Practice Address - Street 2:TEXAS MEDCLINIC
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2000
Practice Address - Country:US
Practice Address - Phone:210-349-5577
Practice Address - Fax:210-491-2843
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131121908Medicaid
TX8D8294Medicare PIN
TX131121908Medicaid
TX8C8071Medicare PIN