Provider Demographics
NPI:1386683977
Name:CAMPBELL, TAMARA (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:JO
Other - Last Name:RORRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:815 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2224
Mailing Address - Country:US
Mailing Address - Phone:817-321-0937
Mailing Address - Fax:469-522-6889
Practice Address - Street 1:1750 NORTH HAMPTON ROAD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:214-946-4397
Practice Address - Fax:214-946-4399
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK28642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044676702Medicaid
G95986Medicare UPIN
TX044676702Medicaid
TX8B6627Medicare PIN