Individual
KELLY MAEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3100 BUDDY OWENS AVE, MCALLEN, TX 78504-6464
(956) 971-0404
(956) 971-0408
Mailing address
818 ROYAL ADELADE DR, COLLEGE STATION, TX 77845-4444
(979) 757-1103
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
L5032
TX
207Q00000X
Family Medicine Physician
L5032
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157550803
—
TX
01
—
8S6084
BCBS
TX
Enumeration date
08/12/2006
Last updated
11/14/2024
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