Individual
DR. JAMES JOSEPH KELLEY IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2900 ACME BRICK PLZ, FORT WORTH, TX 76109-4123
(817) 871-9069
(817) 871-9067
Mailing address
2900 ACME BRICK PLZ, FORT WORTH, TX 76109-4123
(817) 871-9069
(817) 871-9067
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
S4991
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447646906
NPI
TX
01
—
S4991
TEXAS MEDICAL LICENSE
TX
Enumeration date
04/11/2015
Last updated
10/01/2020
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