Healthcare Provider Details

I. General information

NPI: 1053356394
Provider Name (Legal Business Name): ANDREW WILLIAM CAMPBELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25010 OAKHURST DR SUITE 200
SPRING TX
77386-2719
US

IV. Provider business mailing address

25010 OAKHURST DRIVE SUITE 200
SPRING TX
77386-1916
US

V. Phone/Fax

Practice location:
  • Phone: 281-681-8989
  • Fax: 281-681-8787
Mailing address:
  • Phone: 281-681-8989
  • Fax: 281-681-8787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberC. IMMUNOTOXICOLOGY
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberC. IMMUNOTOXICOLOGY
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberG7790
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG7790
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberNEUROTOXICOLOGY
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: