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General NPI Number Information
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NPI Number | 1376565820
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Entity Type | Individual
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Provider Name | RICHARD DWAIN KELLEY MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 13435 N HWY 183 STE 311
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City | AUSTIN
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State | TX
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Zip | 78750-3258
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Country | US
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Telephone | 512-614-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 ALDWYCHE DR
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City | AUSTIN
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State | TX
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Zip | 78704-5913
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Country | US
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Telephone | 512-569-4457
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L6457
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License Number State | TX
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