Healthcare Provider Details

I. General information

NPI: 1275646804
Provider Name (Legal Business Name): DONNA SUE CAMPBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHULT DR
COLUMBUS TX
78934-3016
US

IV. Provider business mailing address

PO BOX 865
COLUMBUS TX
78934-0865
US

V. Phone/Fax

Practice location:
  • Phone: 979-732-2371
  • Fax: 979-732-9242
Mailing address:
  • Phone: 979-732-2371
  • Fax: 979-732-9242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberH7936
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: