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NPI Code Detail

MEDICARE: J.MICHAEL KERLEY, M.D., PLLC

MEDICARE: J.MICHAEL KERLEY, M.D., PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianG3515TX

General Provider Information

NPI Number : 1356620843
Entity Type Code : Organization
Provider Name (Legal Business Name) : J.MICHAEL KERLEY, M.D., PLLC
Provider Business Mailing Address
First Line : 6565 WEST LOOP S
Second Line : STE 400
City : BELLAIRE
State : TX
Zip : 77401-3500
Country : US
Telephone Number : 713-589-6879
Fax Number : 713-795-5801
Provider Business Practice Location Address
First Line : 424 N UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3035
Country : US
Telephone Number : 806-776-8200
Fax Number : 806-771-4177
Authorized Official
Title or Position : OWNER
Name : DR. J MICHAEL KERLEY
Credential : M.D.
Telephone Number : 806-776-8200
Provider Enumeration Date : 08/15/2011
Last Update Date : 02/17/2012

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