Provider Demographics
NPI:1508910233
Name:BLAKELY, GAIL ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:ELIZABETH
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 N MESA ST
Mailing Address - Street 2:#331
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3172
Mailing Address - Country:US
Mailing Address - Phone:915-533-8753
Mailing Address - Fax:
Practice Address - Street 1:1200 ENCLAVE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1764
Practice Address - Country:US
Practice Address - Phone:800-444-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG23272085R0202X
NM75-1142085R0202X
CAG374722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D35517Medicare UPIN