Provider Demographics
NPI:1134179385
Name:CAMPO, SALVATORE R (DO)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:R
Last Name:CAMPO
Suffix:
Gender:M
Credentials:DO
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 140105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-0105
Mailing Address - Country:US
Mailing Address - Phone:214-522-0210
Mailing Address - Fax:214-522-0474
Practice Address - Street 1:1110 N BUCKNER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3487
Practice Address - Country:US
Practice Address - Phone:214-324-1442
Practice Address - Fax:214-324-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8215207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036065301Medicaid
G14787Medicare UPIN
TX611055Medicare PIN
TX00T72SMedicare PIN