MEDICARE: DR. JOSEPH FRANCIS KELLY M.D.

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
1	208600000X	Surgery Physician	01059468A	IN
2	208600000X	Surgery Physician	P9378	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	412749YYPE	OTHER	TX	MEDICARE PTAN

General Provider Information

NPI Number	:	1629041306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH FRANCIS KELLY M.D.

Provider Business Mailing Address
First Line	:	4383 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3307
Country	:	US
Telephone Number	:	210-593-5700
Fax Number	:	210-593-5992

Provider Business Practice Location Address
First Line	:	2632 BROADWAY ST
Second Line	:	SUITE 102 NORTH
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1137
Country	:	US
Telephone Number	:	210-224-1971
Fax Number	:	210-593-5992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2006
Last Update Date	:	07/01/2016

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Directions to “ DR. JOSEPH FRANCIS KELLY M.D.” Practice Location

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