Provider Demographics
NPI:1801127535
Name:DARRYL CAMP MD, PA
Entity type:Organization
Organization Name:DARRYL CAMP MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5123-234-4900
Mailing Address - Street 1:11211 TAYLOR DRAPER LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3916
Mailing Address - Country:US
Mailing Address - Phone:512-324-4900
Mailing Address - Fax:512-504-0856
Practice Address - Street 1:5103 KYLE CENTER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-7864
Practice Address - Country:US
Practice Address - Phone:512-674-9002
Practice Address - Fax:512-342-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK23172084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101146Medicare PIN