Basic Information
| Provider Information | |||||||||
| NPI: | 1689665432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEGEL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA, MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 117614 | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750117614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1061519012 | ||||||||
| FaxNumber: | 2106151905 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 CITYWEST BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136204000 | ||||||||
| FaxNumber: | 7134584229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2005 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP110096 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 82113U | 01 | TX | BLUE CROSS AND BLUE SHIELD | OTHER | 002505802 | 05 | TX | MEDICAID |