Individual
DR. JOSEPH A KELLY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
36065 SANTA FE AVE, FORT CAVAZOS, TX 76544-5060
(254) 288-8000
Mailing address
590 MEDICAL CENTER ROAD, FORT CAVAZOS, TX 76544
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1319
NE
207RP1001X
Pulmonary Disease Physician
Primary
1319
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376982793
ARMY
CO
Enumeration date
06/19/2013
Last updated
07/31/2024
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