Individual
GENE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 N 4TH ST, LONGVIEW, TX 75605-5128
(903) 232-3675
Mailing address
PO BOX 847176, DALLAS, TX 75284-7176
(903) 237-1800
(903) 237-1810
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L1907
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147381101
—
TX
05
—
147381103
—
TX
Enumeration date
02/12/2007
Last updated
03/20/2014
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