MEDICARE: DR. KELLY CAMPBELL D.O.

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	207R00000X	Internal Medicine Physician	583150	TX
2	207P00000X	Emergency Medicine Physician	Q9792	TX

General Provider Information

NPI Number	:	1538524723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY CAMPBELL D.O.

Provider Business Mailing Address
First Line	:	7101 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-4913
Country	:	US
Telephone Number	:	361-761-3540
Fax Number	:	361-761-3689

Provider Business Practice Location Address
First Line	:	6238 BOCA RATON CIR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78413-2636
Country	:	US
Telephone Number	:	925-818-5591
Fax Number	:

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

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	11/18/2016

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Directions to “ DR. KELLY CAMPBELL D.O.” Practice Location

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