Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | F4153 | TX |
Y | 207VE0102X | Reproductive Endocrinologist | F4153 | TX |
NPI | 1407916935 |
---|---|
Provider Name | Mae Ellen Kelver |
First Address | Galveston, TX 77555-5302 |
Second Address | Galveston, TX 77555-5302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 02/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
129734301 | (05) | TX |
B23908 | (02) | TX |