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Organization
KELLY L WIMBERLY MD PA
Active
Organization
KELLY L WIMBERLY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY L WIMBERLY MD (OWNER)
(972) 239-4441
Entity
Organization
Contact information
Practice address
17101 PRESTON RD, SUITE 200, DALLAS, TX 75248-1331
(972) 239-4441
(972) 239-1597
Mailing address
17101 PRESTON RD, SUITE 200, DALLAS, TX 75248-1331
(972) 239-4441
(972) 239-1597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
J3002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH1426
MEDICARE RR GROUP NUMBER
TX
01
—
P00474586
MEDICARE RR PIN
TX
Enumeration date
07/13/2006
Last updated
07/24/2008
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