Provider Demographics
NPI:1982808549
Name:GAMILLA-CRUDO, ANN KATHLEEN NOBLEJAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN KATHLEEN
Middle Name:NOBLEJAS
Last Name:GAMILLA-CRUDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3433 COVE VIEW BLVD
Mailing Address - Street 2:#2308
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77554-8175
Mailing Address - Country:US
Mailing Address - Phone:409-877-2814
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:4.200 JOHN SEALY ANNEX
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0562
Practice Address - Country:US
Practice Address - Phone:409-772-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026290207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3847415795OtherMYUTMB 3847415795-COMMERCIAL NUMBER