Provider Demographics
NPI:1366464745
Name:CAMP, DARRYL SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:SHANE
Last Name:CAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11211 TAYLOR DRAPER LN STE 202
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3971
Mailing Address - Country:US
Mailing Address - Phone:512-674-9070
Mailing Address - Fax:512-342-9949
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-551-0846
Practice Address - Fax:512-828-8785
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK23172084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096306807Medicaid
TXTXB101147Medicare PIN
TX096306807Medicaid