Provider Demographics
NPI:1326058363
Name:CAMPBELL, BRENT BARTON (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:BARTON
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 1:1111 W FRANK AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-639-6335
Mailing Address - Fax:936-639-6980
Practice Address - Street 1:1111 W FRANK AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-639-6335
Practice Address - Fax:936-639-6980
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3118208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149258902Medicaid
TX752712166OtherTAX IDENTIFICATION NUMBER
TXG30861Medicare UPIN
TX149258902Medicaid