MEDICARE: DR. GAZELLE CRAIG 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	207Q00000X	Family Medicine Physician	252279-1	NY
2	208600000X	Surgery Physician	252279-1	NY
3	208VP0000X	Pain Medicine Physician	Q2757	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A400015770	OTHER	NY	MEDICARE PTAN

General Provider Information

NPI Number	:	1730346826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAZELLE CRAIG D.O.

Provider Business Mailing Address
First Line	:	6303 GULFTON ST SUITE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081
Country	:	US
Telephone Number	:	832-804-6645
Fax Number	:	832-804-6993

Provider Business Practice Location Address
First Line	:	6303 GULFTON ST SUITE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081
Country	:	US
Telephone Number	:	832-804-6645
Fax Number	:	832-804-6993

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

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	06/29/2016

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Directions to “ DR. GAZELLE CRAIG D.O.” Practice Location

Language	Start Address	Practice Location

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