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General NPI Number Information
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NPI Number | 1336335223
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Entity Type | Individual
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Provider Name | PHILIP LLEWELLYN KELTON JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 3600 GASTON AVE WADLEY TOWER SUITE 1054
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 214-826-8950
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Fax | 214-826-3434
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Provider Business Mailing Address
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Address Line | 3600 GASTON AVE WADLEY TOWER SUITE 1054
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City | DALLAS
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State | TX
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Zip | 75246-1800
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Country | US
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Telephone | 214-826-8950
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Fax | 214-826-3434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | D7112
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License Number State | TX
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