Provider Demographics
NPI:1952385494
Name:KWELLER, HOWARD EVAN (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:EVAN
Last Name:KWELLER
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:PO BOX 8128
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8128
Mailing Address - Country:US
Mailing Address - Phone:903-454-8111
Mailing Address - Fax:903-454-1680
Practice Address - Street 1:4101 WESLEY STREET
Practice Address - Street 2:STE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-454-8111
Practice Address - Fax:903-454-1680
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5613207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037478702Medicaid
TX037478702Medicaid
TX262102YLZNMedicare PIN