# MODERN MALE T-CLINIC, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518389022
- **Authorized official:** SALVATORE CAMPO (OWNER)
- **Authorized official phone:** (800) 246-5698

## Contact information

- **Practice address:** 15340 DALLAS PKWY, STE2400, DALLAS, TX 75248-4636
- **Practice address phone:** (800) 246-5698
- **Mailing address:** 15340 DALLAS PKWY, STE2400, DALLAS, TX 75248-4636
- **Mailing address phone:** (800) 246-5698

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2014
- **Last updated:** 01/17/2014