Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 54083 | TN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | S7185 | TX |
NPI | 1023452125 |
---|---|
Provider Name | Matthew Edward Campbell |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75235-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2013 |
Last Update Date | 06/08/2021 |