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General NPI Number Information
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NPI Number | 1790738565
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Entity Type | Individual
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Provider Name | WARREN DOUGLAS MCKELVY MD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 10/29/2007
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Provider Practice Location Address
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Address Line | 313 W. COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-625-1371
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Fax | 575-625-1490
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Provider Business Mailing Address
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Address Line | 313 W. COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-625-1371
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Fax | 575-625-1490
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 77-217
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License Number State | NM
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