Healthcare Provider Details

I. General information

NPI: 1821471780
Provider Name (Legal Business Name): PREVITY SURGICAL CLEAR LAKE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BLOSSOM ST SUITE 285
WEBSTER TX
77598-4204
US

IV. Provider business mailing address

740 HOSPITAL DR SUITE 280
BEAUMONT TX
77701-4664
US

V. Phone/Fax

Practice location:
  • Phone: 281-487-3313
  • Fax: 281-487-3316
Mailing address:
  • Phone: 409-835-9500
  • Fax: 409-835-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. GARRETT KEITH PEEL
Title or Position: OWNER
Credential: M.D.
Phone: 409-835-9500