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General NPI Number Information
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NPI Number | 1841705100
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Entity Type | Organization
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Legal Business Name | KTD, PLLC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 2216 W WASHINGTON
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City | STEPHENVILLE
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State | TX
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Zip | 76401-7640
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Country | US
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Telephone | 254-965-5888
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Fax | 254-965-5865
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Provider Business Mailing Address
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Address Line | 2216 W WASHINGTON ST
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City | STEPHENVILLE
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State | TX
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Zip | 76401-3838
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Country | US
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Telephone | 254-965-5888
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Fax | 254-965-5865
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Authorized Official
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Title or Position | PHYSICIAN/SOLE MEMBER
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Name | DR. KELLY S. DOGGETT
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Credential | MD
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Telephone | 254-965-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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