Healthcare Provider Details

I. General information

NPI: 1134179385
Provider Name (Legal Business Name): SALVATORE R CAMPO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N BUCKNER BLVD SUITE 100
DALLAS TX
75218-3487
US

IV. Provider business mailing address

PO BOX 140105
DALLAS TX
75214-0105
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-1442
  • Fax: 214-324-1444
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberJ8215
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: