Provider Demographics
NPI:1851384648
Name:CAMPBELL, DALE KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:KEITH
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HOSPITAL DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2415
Mailing Address - Country:US
Mailing Address - Phone:903-201-6405
Mailing Address - Fax:903-641-7502
Practice Address - Street 1:401 HOSPITAL DR STE 140
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2415
Practice Address - Country:US
Practice Address - Phone:903-201-6405
Practice Address - Fax:903-641-7502
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB131452OtherMEDICARE
TX099742105Medicaid
TX099742105Medicaid