Provider Demographics
NPI:1720167315
Name:MARTIN-DEL-CAMPO, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:MARTIN-DEL-CAMPO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 INTERSTATE 10 N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-2538
Mailing Address - Country:US
Mailing Address - Phone:409-899-1696
Mailing Address - Fax:409-833-1088
Practice Address - Street 1:85 INTERSTATE 10 N
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2538
Practice Address - Country:US
Practice Address - Phone:409-899-1696
Practice Address - Fax:409-833-1088
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG97702084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66881Medicare UPIN
TX00JQ68Medicare ID - Type Unspecified