Provider Demographics
NPI:1275646804
Name:CAMPBELL, DONNA SUE (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:SUE
Last Name:CAMPBELL
Suffix:
Gender:F
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:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-0865
Mailing Address - Country:US
Mailing Address - Phone:979-732-2371
Mailing Address - Fax:979-732-9242
Practice Address - Street 1:110 SHULT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3016
Practice Address - Country:US
Practice Address - Phone:979-732-2371
Practice Address - Fax:979-732-9242
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7936207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140122604Medicaid
TX140122604Medicaid
TXE88126Medicare UPIN