Provider Demographics
NPI:1184690083
Name:DUNCAN, KELLY HERNE (MD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:HERNE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:HERNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:430 S MASON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2447
Mailing Address - Country:US
Mailing Address - Phone:281-392-3803
Mailing Address - Fax:281-392-2766
Practice Address - Street 1:430 S MASON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2447
Practice Address - Country:US
Practice Address - Phone:281-392-3803
Practice Address - Fax:281-392-2766
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2317207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F0819OtherMEDICARE - BRAZORIA
3833541OtherAETNA HMO
8J9633OtherBCBS
P00264644OtherRR MEDICARE - BRAZORIA
7921718OtherAETNA PPO
TX8F4133Medicare PIN
TX8D7571Medicare PIN
TX8F0819Medicare PIN
3833541OtherAETNA HMO