Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M9401 | TX |
Y | 207XS0117X | Orthopaedic Spine Surgeon | M9401 | TX |
NPI | 1225298094 |
---|---|
Provider Name | Zachary Lamar Kelley |
First Address | Dallas, TX 75208-4263 |
Second Address | Corsicana, TX 75110-2489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2008 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8L16199 | (02) |