Healthcare Provider Details

I. General information

NPI: 1972523223
Provider Name (Legal Business Name): KENDALL MARVIN CAMPBELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KENDALL MARVIN CAMPBELL

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-1120
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-1120
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-2166
  • Fax: 409-772-2663
Mailing address:
  • Phone: 409-747-6240
  • Fax: 409-772-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47524
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME86295
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2016-02575
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT9359
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: