Provider Demographics
NPI:1457314627
Name:MCKELLAR, J. MORRIS (MD)
Entity Type:Individual
Prefix:
First Name:J.
Middle Name:MORRIS
Last Name:MCKELLAR
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 1:304 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2328
Mailing Address - Country:US
Mailing Address - Phone:903-572-5882
Mailing Address - Fax:903-572-7330
Practice Address - Street 1:304 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2328
Practice Address - Country:US
Practice Address - Phone:903-572-5882
Practice Address - Fax:903-572-7330
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8708207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24768Medicare UPIN
TX00PE44Medicare ID - Type Unspecified