MEDICARE: DR. KELLY ALBERDA 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	207Q00000X	Family Medicine Physician	L9995	TX

General Provider Information

NPI Number	:	1972525376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY ALBERDA M.D.

Provider Business Mailing Address
First Line	:	5222 BURNET RD STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2433
Country	:	US
Telephone Number	:	512-459-9889
Fax Number	:	512-389-2935

Provider Business Practice Location Address
First Line	:	5222 BURNET RD STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-2433
Country	:	US
Telephone Number	:	512-459-9889
Fax Number	:	512-389-2935

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/15/2024

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