Individual
DR. ANDREW O'KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3593 E GRANDE BLVD, TYLER, TX 75707-1400
(903) 839-2585
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R2430
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
373525002
—
TX
01
—
692398
MEDICARE
TX
01
—
8JX739
BCBS
TX
01
—
8KE926
BCBS
TX
Enumeration date
03/27/2015
Last updated
11/12/2018
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