Provider Demographics
NPI:1972523223
Name:CAMPBELL, KENDALL MARVIN (MD)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARVIN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENDALL
Other - Middle Name:MARVIN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:DEPT 710
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-1120
Mailing Address - Country:US
Mailing Address - Phone:409-747-6240
Mailing Address - Fax:409-772-2663
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-1120
Practice Address - Country:US
Practice Address - Phone:409-772-2166
Practice Address - Fax:409-772-2663
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47524207Q00000X
FLME86295207Q00000X
NC2016-02575207Q00000X
TXT9359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC19NZDOtherBCBS OF NC
NC1972523223Medicaid
NC19NZDOtherBCBS OF NC