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General NPI Number Information
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NPI Number | 1851459457
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Entity Type | Organization
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Legal Business Name | KELLY W LOBB MD PA
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 1600 JOSEPH DR
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City | BRYAN
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State | TX
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Zip | 77802-1502
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Country | US
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Telephone | 979-821-7527
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Fax | 979-821-7528
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Provider Business Mailing Address
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Address Line | 1600 JOSEPH DR
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City | BRYAN
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State | TX
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Zip | 77802-1502
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Country | US
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Telephone | 979-821-7527
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Fax | 979-821-7528
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KELLY WENDELL LOBB
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Credential | M.D.
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Telephone | 979-821-7527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | K8939
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License Number State | TX
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