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General NPI Number Information
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NPI Number | 1982666434
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Entity Type | Organization
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Legal Business Name | PHILIP L KELTON JR MD PA
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Dates
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Enumeration Date | 04/03/2006
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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 | 75246-1910
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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 LB-78 WADLEY TOWER SUITE 1054
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City | DALLAS
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State | TX
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Zip | 75246-1910
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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 | OWNER PRESIDENT
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Name | PHILIP LLEWELLYN KELTON JR.
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Credential | MD
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Telephone | 214-826-8950
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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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