Provider Demographics
NPI:1417953696
Name:CAMPBELL, NEIL A (DPM)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 762
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-0762
Mailing Address - Country:US
Mailing Address - Phone:361-741-3668
Mailing Address - Fax:361-293-7058
Practice Address - Street 1:2550 N ESPLANADE ST
Practice Address - Street 2:
Practice Address - City:CUERO
Practice Address - State:TX
Practice Address - Zip Code:77954-4736
Practice Address - Country:US
Practice Address - Phone:361-275-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1318213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039748102Medicaid
TX039748103Medicaid
TXU56972Medicare UPIN