MEDICARE: LAUREN S CAMPBELL MD 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	207N00000X	Dermatology Physician	N6207	TX

General Provider Information

NPI Number	:	1790227221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREN S CAMPBELL MD PA

Provider Business Mailing Address
First Line	:	27700 NORTHWEST FREEWAY
Second Line	:	SUITE 490
City	:	CYPRESS
State	:	TX
Zip	:	77433-6766
Country	:	US
Telephone Number	:	281-895-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 PAUL REVERE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-6111
Country	:	US
Telephone Number	:	713-505-5324
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, PHYSICIAN
Name	:	DR. LAUREN SUZANNE CAMPBELL
Credential	:	M.D.
Telephone Number	:	832-455-9822

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	04/24/2017

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