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Individual

DR. RUSSELL PHELPS KELLEY IV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2825 OAK LAWN AVE UNIT 192749, DALLAS, TX 75219-4688
(510) 689-9500
(877) 880-2039
Mailing address
2825 OAK LAWN AVE UNIT 192749, DALLAS, TX 75219-4688
(510) 683-9500
(877) 880-2039

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1018091
MA
2085R0202X
Diagnostic Radiology Physician
2024-03651
NC
2085R0202X
Diagnostic Radiology Physician
A135999
CA
2085R0202X
Diagnostic Radiology Physician
S3004
TX

Other

Enumeration date
06/11/2013
Last updated
12/20/2024
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