Healthcare Provider Details

I. General information

NPI: 1336138577
Provider Name (Legal Business Name): WAEL TELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 03/07/2023
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 6TH ST
LUBBOCK TX
79416-4733
US

IV. Provider business mailing address

4407 6TH ST
LUBBOCK TX
79416-4733
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-5864
  • Fax: 806-771-9009
Mailing address:
  • Phone: 806-771-5864
  • Fax: 806-771-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberK2603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: