Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1245 | TX |
N | 222Z00000X | Podiatrist | 1245 | TX |
Y | 224P00000X | Prosthetist | 1245 | TX |
NPI | 1376744912 |
---|---|
Provider Name | Mr. John D Kelley |
First Address | Richardson, TX 75080-4054 |
Second Address | Richardson, TX 75080-4054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 15/03/2012 |