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General NPI Number Information
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NPI Number | 1821471780
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Entity Type | Organization
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Legal Business Name | PREVITY SURGICAL CLEAR LAKE, PLLC
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/09/2015
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Provider Practice Location Address
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Address Line | 250 BLOSSOM ST SUITE 285
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City | WEBSTER
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State | TX
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Zip | 77598-4204
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Country | US
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Telephone | 281-487-3313
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Fax | 281-487-3316
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Provider Business Mailing Address
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Address Line | 740 HOSPITAL DR SUITE 280
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City | BEAUMONT
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State | TX
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Zip | 77701-4664
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Country | US
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Telephone | 409-835-9500
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Fax | 409-835-0098
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARRETT KEITH PEEL
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Credential | M.D.
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Telephone | 409-835-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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