Provider Demographics
NPI:1356620843
Name:J.MICHAEL KERLEY, M.D., PLLC
Entity type:Organization
Organization Name:J.MICHAEL KERLEY, M.D., PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-776-8200
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:STE 400
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-589-6879
Mailing Address - Fax:713-795-5801
Practice Address - Street 1:424 N UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3035
Practice Address - Country:US
Practice Address - Phone:806-776-8200
Practice Address - Fax:806-771-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG35152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB141527Medicare PIN