Provider Demographics
NPI:1114989092
Name:CAMPBELL, ODETTE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ODETTE
Middle Name:LOUISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5072 W PLANO PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4475
Mailing Address - Country:US
Mailing Address - Phone:469-671-0900
Mailing Address - Fax:972-256-2943
Practice Address - Street 1:5072 W PLANO PKWY STE 220
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4475
Practice Address - Country:US
Practice Address - Phone:469-671-0900
Practice Address - Fax:972-256-2943
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9609207R00000X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1396087-14Medicaid
TXTXB149447Medicare PIN
TXD71611Medicare UPIN
TX1396087-14Medicaid