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General NPI Number Information
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NPI Number | 1912904731
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Entity Type | Individual
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Provider Name | BLAIR WILLIAM KRELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 214 PARKING WAY ST
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5227
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Country | US
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Telephone | 979-299-3376
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Fax | 979-299-3797
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Provider Business Mailing Address
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Address Line | 214 PARKING WAY ST
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5227
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Country | US
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Telephone | 979-299-3376
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Fax | 979-299-3197
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | L1637
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | L1637
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License Number State | TX
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