Provider Demographics
NPI:1285632737
Name:GAYLE, LELVE JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:LELVE
Middle Name:JUSTIN
Last Name:GAYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:979-704-6174
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6453207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275726853OtherNPI CLINIC
TX187842301Medicaid
TX125123305Medicaid
TX125123307Medicaid
TX1821185299OtherNPI AGENCY
TX187842302Medicaid
TX1821185299OtherNPI AGENCY
TX125123305Medicaid
TX187842302Medicaid