Provider Demographics
NPI:1245252493
Name:KERLEY, THOMAS KARL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KARL
Last Name:KERLEY
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 1:602 N KEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-1106
Mailing Address - Country:US
Mailing Address - Phone:512-556-3682
Mailing Address - Fax:
Practice Address - Street 1:602 N KEY AVE
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-1106
Practice Address - Country:US
Practice Address - Phone:512-556-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2123207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F43308Medicare UPIN
8A7933Medicare ID - Type Unspecified