MEDICARE: JEREMY CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	2158422	TX

General Provider Information

NPI Number	:	1235947227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY CAMPBELL

Provider Business Mailing Address
First Line	:	101 RHOADES ST
Second Line	:
City	:	AZLE
State	:	TX
Zip	:	76020-4422
Country	:	US
Telephone Number	:	817-798-4901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 S LAS VEGAS TRL
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-3350
Country	:	US
Telephone Number	:	817-246-4995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2024
Last Update Date	:	12/31/2024

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Directions to “ JEREMY CAMPBELL ” Practice Location

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