Healthcare Provider Details

I. General information

NPI: 1174837058
Provider Name (Legal Business Name): DARRYL CAMP MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W 38TH ST
AUSTIN TX
78705-1006
US

IV. Provider business mailing address

5103 KYLE CENTER DR SUITE 104
KYLE TX
78640-6163
US

V. Phone/Fax

Practice location:
  • Phone: 512-551-0846
  • Fax:
Mailing address:
  • Phone: 512-551-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberK2317
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK2317
License Number StateTX

VIII. Authorized Official

Name: DARRYL S CAMP
Title or Position: PRESIDENT
Credential: MD
Phone: 512-551-0846