Provider Demographics
NPI:1578859427
Name:CAMPANA, ROGER ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ENRIQUE
Last Name:CAMPANA
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 1:1331 W GRAND PKWY N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2710
Mailing Address - Country:US
Mailing Address - Phone:281-392-8620
Mailing Address - Fax:281-392-2258
Practice Address - Street 1:1331 W GRAND PKWY N
Practice Address - Street 2:SUITE 230
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2710
Practice Address - Country:US
Practice Address - Phone:281-392-8620
Practice Address - Fax:281-392-2258
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine