Provider Demographics
NPI:1740259985
Name:CAMPBELL, FRED C JR (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:C
Last Name:CAMPBELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8300 FLOYD CURL DR FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3931
Mailing Address - Country:US
Mailing Address - Phone:210-450-9020
Mailing Address - Fax:210-450-4962
Practice Address - Street 1:8300 FLOYD CURL DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9020
Practice Address - Fax:210-450-4962
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117874109OtherCSHCN
TX117874108Medicaid
TX117874108Medicaid