Healthcare Provider Details

I. General information

NPI: 1386761252
Provider Name (Legal Business Name): OLA GAIL CAVERLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEADOWBROOK DRIVE
PECOS TX
79772-7338
US

IV. Provider business mailing address

200 MEADOWBROOK DRIVE
PECOS TX
79772-7338
US

V. Phone/Fax

Practice location:
  • Phone: 432-447-0565
  • Fax: 432-447-5053
Mailing address:
  • Phone: 432-447-0565
  • Fax: 432-447-5053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberF8045
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: