Healthcare Provider Details

I. General information

NPI: 1699700724
Provider Name (Legal Business Name): GAIL BLAKLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL MOORE MD

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 KATY FREEWAY SUITE 130
HOUSTON TX
77007
US

IV. Provider business mailing address

5151 KATY FREEWAY SUITE 130
HOUSTON TX
77007
US

V. Phone/Fax

Practice location:
  • Phone: 713-225-0463
  • Fax: 713-225-6899
Mailing address:
  • Phone: 713-225-0463
  • Fax: 713-225-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberF4302
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: