Provider Demographics
NPI:1003206285
Name:L JUSTIN GAYLE MD PLLC
Entity Type:Organization
Organization Name:L JUSTIN GAYLE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LELVE
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-229-9189
Mailing Address - Street 1:1602 ROCK PRAIRIE RD STE 460
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8309
Mailing Address - Country:US
Mailing Address - Phone:979-704-6173
Mailing Address - Fax:
Practice Address - Street 1:1602 ROCK PRAIRIE RD STE 460
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8309
Practice Address - Country:US
Practice Address - Phone:979-704-6173
Practice Address - Fax:979-704-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6453207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty