Basic Information
| Provider Information | |||||||||
| NPI: | 1174956726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6301 GASTON AVE | ||||||||
| Address2: | SUITE 100 WEST TOWER | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752143922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148273610 | ||||||||
| FaxNumber: | 2148214017 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 GASTON AVE | ||||||||
| Address2: | SUITE 100 WEST TOWER | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752143922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148273610 | ||||||||
| FaxNumber: | 2148214017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2013 | ||||||||
| LastUpdateDate: | 08/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT82578 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.