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Organization

PHILIP L KELTON JR MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PHILIP LLEWELLYN KELTON JR. MD (OWNER PRESIDENT)
(214) 826-8950
Entity
Organization

Contact information

Practice address
3600 GASTON AVE, WADLEY TOWER SUITE 1054, DALLAS, TX 75246-1910
(214) 826-8950
(214) 826-3434
Mailing address
3600 GASTON AVE LB-78, WADLEY TOWER SUITE 1054, DALLAS, TX 75246-1910
(214) 826-8950
(214) 826-3434

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
D7112
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
04616699757
OK
05
115836201
TX
Enumeration date
04/03/2006
Last updated
08/20/2010
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