Organization
KELLY R. KUNKEL, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY RAYMOND KUNKEL M.D. (PRESIDENT)
(817) 335-5200
Entity
Organization
Contact information
Practice address
1830 8TH AVE, FORT WORTH, TX 76110-1391
(817) 335-5200
(817) 923-0780
Mailing address
1830 8TH AVE, FORT WORTH, TX 76110-1391
(817) 335-5200
(817) 923-0780
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
208650122X
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0025AA
MEDICARE IDENTIFICATION NUMBER
TX
Enumeration date
12/31/2013
Last updated
12/31/2013
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