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General NPI Number Information
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NPI Number | 1285632737
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Entity Type | Individual
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Provider Name | LELVE JUSTIN GAYLE MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1602 ROCK PRAIRIE RD STE 460
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8309
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Country | US
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Telephone | 979-704-6173
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Fax | 979-704-6174
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Provider Business Mailing Address
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Address Line | 1602 ROCK PRAIRIE RD STE 460
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City | COLLEGE STATION
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State | TX
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Zip | 77845-8309
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Country | US
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Telephone | 979-704-6173
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Fax | 979-704-6174
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | J6453
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License Number State | TX
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