Healthcare Provider Details

I. General information

NPI: 1881990216
Provider Name (Legal Business Name): DALLAS DOCTORS PAIN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N. BUCKNER BLVD., SUITE 100
DALLAS TX
75218
US

IV. Provider business mailing address

1151 N BUCKNER BLVD 100
DALLAS TX
75218
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-9400
  • Fax: 214-324-9402
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SALVATORE R. CAMPO
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 214-324-9400