Healthcare Provider Details

I. General information

NPI: 1710706635
Provider Name (Legal Business Name): SIMON PAUL KELLEY MBCHB, PHD, FRCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN STREET SUITE D.0650.15
HOUSTON TX
77030
US

IV. Provider business mailing address

2455 DUNSTAN RD APT 420
HOUSTON TX
77005
US

V. Phone/Fax

Practice location:
  • Phone: 713-447-6934
  • Fax:
Mailing address:
  • Phone: 647-239-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number48300
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: