Basic Information
| Provider Information | |||||||||
| NPI: | 1073046447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | ROOSEVELT | ||||||||
| MiddleName: | V | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 W SOLAR DR | ||||||||
| Address2: | |||||||||
| City: | MISSION | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785747105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196848111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 S BUSINESS HIGHWAY 281 | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785390287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562710130 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | T3594 | TX | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.