Provider Demographics
NPI:1932298387
Name:KELLEY, JEFFREY ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12522 GREENSPOINT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1308
Mailing Address - Country:US
Mailing Address - Phone:281-876-2300
Mailing Address - Fax:281-876-0321
Practice Address - Street 1:12522 GREENSPOINT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1308
Practice Address - Country:US
Practice Address - Phone:281-876-2300
Practice Address - Fax:281-876-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HW33Medicare ID - Type Unspecified
TXA67244Medicare UPIN