Provider Demographics
NPI:1730346826
Name:CRAIG, GAZELLE (DO)
Entity type:Individual
Prefix:DR
First Name:GAZELLE
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 GULFTON ST SUITE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:832-804-6645
Mailing Address - Fax:832-804-6993
Practice Address - Street 1:6303 GULFTON ST SUITE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081
Practice Address - Country:US
Practice Address - Phone:832-804-6645
Practice Address - Fax:832-804-6993
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-18
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252279-1207Q00000X, 208600000X
TXQ2757208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400015770OtherMEDICARE PTAN