MEDICARE: GARY L CAMPBELL DO PA

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	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1699175059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY L CAMPBELL DO PA

Provider Business Mailing Address
First Line	:	6116 OAKBEND TRL
Second Line	:	STE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-346-7800
Fax Number	:	817-346-7804

Provider Business Practice Location Address
First Line	:	6116 OAKBEND TRL
Second Line	:	STE 112
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3925
Country	:	US
Telephone Number	:	817-346-7800
Fax Number	:	817-346-7804

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	GARY LEE CAMPBELL
Credential	:	DO
Telephone Number	:	210-744-6729

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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Directions to “GARY L CAMPBELL DO PA ” Practice Location

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