Healthcare Provider Details

I. General information

NPI: 1619965100
Provider Name (Legal Business Name): CREED W ABELL IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHULT DR
COLUMBUS TX
78934-3016
US

IV. Provider business mailing address

800 ROCKMEAD DR STE 210
KINGWOOD TX
77339
US

V. Phone/Fax

Practice location:
  • Phone: 281-359-7788
  • Fax: 281-359-7888
Mailing address:
  • Phone: 281-359-7788
  • Fax: 281-359-7888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberH8559
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: