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General NPI Number Information
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NPI Number | 1235947227
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Entity Type | Individual
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Provider Name | JEREMY CAMPBELL
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Gender | Male
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Dates
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Enumeration Date | 12/21/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 1950 S LAS VEGAS TRL
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City | WHITE SETTLEMENT
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State | TX
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Zip | 76108-3350
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Country | US
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Telephone | 817-246-4995
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Fax |
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Provider Business Mailing Address
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Address Line | 101 RHOADES ST
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City | AZLE
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State | TX
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Zip | 76020-4422
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Country | US
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Telephone | 817-798-4901
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2158422
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License Number State | TX
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