Provider Demographics
NPI:1376556456
Name:WILL, KELLY RAY (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:RAY
Last Name:WILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11970 N CENTRAL EXPY, #510
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3768
Mailing Address - Country:US
Mailing Address - Phone:972-707-2800
Mailing Address - Fax:972-707-2801
Practice Address - Street 1:7515 GREENVILLE AVE STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3849
Practice Address - Country:US
Practice Address - Phone:972-777-6101
Practice Address - Fax:972-833-2005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8557207LP2900X, 208VP0000X, 208VP0014X
TXG8667207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE09472Medicare UPIN
TX80H482Medicare ID - Type Unspecified