Provider Demographics
NPI:1770890113
Name:GARY L. APPELT, MD,PA
Entity type:Organization
Organization Name:GARY L. APPELT, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:APPELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-830-1014
Mailing Address - Street 1:633 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5412
Mailing Address - Country:US
Mailing Address - Phone:979-830-1014
Mailing Address - Fax:979-836-9103
Practice Address - Street 1:633 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5412
Practice Address - Country:US
Practice Address - Phone:979-830-1014
Practice Address - Fax:979-836-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2443208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035336901Medicaid
TX00PF13Medicare PIN
TX035336901Medicaid