Provider Demographics
NPI:1962650689
Name:CAMPBELL, RAYMOND IV (RD/LD)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:CAMPBELL
Suffix:IV
Gender:M
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75402-4330
Mailing Address - Country:US
Mailing Address - Phone:903-352-9643
Mailing Address - Fax:
Practice Address - Street 1:525 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-4330
Practice Address - Country:US
Practice Address - Phone:903-352-9643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT06407133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered