Provider Demographics
NPI:1073506739
Name:BLEVINS, KELLY W (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:W
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-8800
Mailing Address - Fax:281-367-1323
Practice Address - Street 1:9305 PINECROFT DR STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3482
Practice Address - Country:US
Practice Address - Phone:713-486-8800
Practice Address - Fax:281-367-1323
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2022-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9468207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096697002Medicaid
TX096697002Medicaid
TXBL087454JMedicare ID - Type Unspecified