Provider Demographics
NPI:1447646906
Name:KELLEY, JAMES JOSEPH IV (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:KELLEY
Suffix:IV
Gender:M
Credentials:DO
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Mailing Address - Street 1:2900 ACME BRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4123
Mailing Address - Country:US
Mailing Address - Phone:817-871-9069
Mailing Address - Fax:817-871-9067
Practice Address - Street 1:2900 ACME BRICK PLZ
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4123
Practice Address - Country:US
Practice Address - Phone:817-871-9069
Practice Address - Fax:817-871-9067
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS4991208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447646906OtherNPI
TXS4991OtherTEXAS MEDICAL LICENSE