MEDICARE: HOUSTON MALE HEALTH CLINIC, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528503257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON MALE HEALTH CLINIC, PLLC

Provider Business Mailing Address
First Line	:	12221 MERIT DR
Second Line	:	SUITE 620
City	:	DALLAS
State	:	TX
Zip	:	75251-2202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 DURHAM DR
Second Line	:	SUITE 4
City	:	HOUSTON
State	:	TX
Zip	:	77007-2271
Country	:	US
Telephone Number	:	214-506-2610
Fax Number	:

Authorized Official
Title or Position	:	OWENR / DIRECTOR / PHYSICIAN
Name	:	SALVATORE R CAMPO
Credential	:
Telephone Number	:	214-506-2610

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	02/17/2017

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