Provider Demographics
NPI:1306844394
Name:MCKELVEY, THOMAS GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GREGORY
Last Name:MCKELVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3715 DAUPHIN ST
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-1771
Mailing Address - Country:US
Mailing Address - Phone:251-410-4001
Mailing Address - Fax:251-410-4002
Practice Address - Street 1:3715 DAUPHIN ST
Practice Address - Street 2:SUITE 7A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1771
Practice Address - Country:US
Practice Address - Phone:251-410-4001
Practice Address - Fax:251-410-4002
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00018426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-76004OtherBLUE CROSS
AL009992795Medicaid
AL0410076OtherUNITED HEALTHCARE
AL511-76004OtherBLUE CROSS
AL009992795Medicaid