Healthcare Provider Details

I. General information

NPI: 1366464745
Provider Name (Legal Business Name): DARRYL SHANE CAMP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY SUITE 300
KYLE TX
78640-6178
US

IV. Provider business mailing address

11211 TAYLOR DRAPER LN STE 202
AUSTIN TX
78759-3971
US

V. Phone/Fax

Practice location:
  • Phone: 512-551-0846
  • Fax: 512-828-8785
Mailing address:
  • Phone: 512-674-9070
  • Fax: 512-342-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: