Individual
MR. KELLY ROBERT GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
3211 N 4TH ST, STE B, LONGVIEW, TX 75605-5145
(903) 758-8346
(903) 757-7876
Mailing address
400 S HENDERSON ST, FORT WORTH, TX 76104-1017
(817) 335-2583
(817) 335-2597
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
50324
TX
Other
Enumeration date
05/23/2008
Last updated
05/23/2008
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