Provider Demographics
NPI:1629041306
Name:KELLY, JOSEPH FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:KELLY
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 1:4383 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3307
Mailing Address - Country:US
Mailing Address - Phone:210-593-5700
Mailing Address - Fax:210-593-5992
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:SUITE 102 NORTH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1137
Practice Address - Country:US
Practice Address - Phone:210-224-1971
Practice Address - Fax:210-593-5992
Is Sole Proprietor?:No
Enumeration Date:2006-02-11
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059468A208600000X
TXP9378208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX412749YYPEOtherMEDICARE PTAN