Provider Demographics
NPI:1669474946
Name:CAMPBELL, SCOTT W (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2338
Mailing Address - Country:US
Mailing Address - Phone:903-577-6000
Mailing Address - Fax:254-245-9178
Practice Address - Street 1:2001 N JEFFERSON AVE STE 203
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2310
Practice Address - Country:US
Practice Address - Phone:903-434-8880
Practice Address - Fax:903-434-8881
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7678207L00000X, 207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX169386306Medicaid
TX257833ZJC1Medicare PIN
CO99178338Medicaid