Individual
KELLY W RISING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
755 N 11TH ST, SUITE P4200, BEAUMONT, TX 77702-1501
(409) 899-1499
(409) 899-1354
Mailing address
755 N 11TH ST, SUITE P4200, BEAUMONT, TX 77702-1501
(409) 899-1499
(409) 899-1354
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J1129
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124919502
—
TX
01
—
160036971
RAILROAD MEDICARE
TX
Enumeration date
09/06/2005
Last updated
05/29/2008
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