Provider Demographics
NPI:1376561647
Name:KELLEY, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7069 US HIGHWAY 67 E
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567-4583
Mailing Address - Country:US
Mailing Address - Phone:903-244-4850
Mailing Address - Fax:903-671-7286
Practice Address - Street 1:7069 US HIGHWAY 67 E
Practice Address - Street 2:
Practice Address - City:MAUD
Practice Address - State:TX
Practice Address - Zip Code:75567-4583
Practice Address - Country:US
Practice Address - Phone:903-244-4850
Practice Address - Fax:903-671-7286
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7726207Q00000X
TXQ1843207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F6405Medicare PIN