MEDICARE: DR. COURTNEY BROOKE CAMPBELL MD

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	U6695	TX

General Provider Information

NPI Number	:	1730676925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY BROOKE CAMPBELL MD

Provider Business Mailing Address
First Line	:	1320 HEMPHILL ST STE 350
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 HEMPHILL ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76104-4714
Country	:	US
Telephone Number	:	956-796-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	09/19/2023

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