Provider Demographics
NPI:1710706635
Name:KELLEY, SIMON PAUL (MBCHB, PHD, FRCS)
Entity type:Individual
Prefix:DR
First Name:SIMON
Middle Name:PAUL
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MBCHB, PHD, FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 DUNSTAN RD
Mailing Address - Street 2:APT 420
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005
Mailing Address - Country:US
Mailing Address - Phone:647-239-6354
Mailing Address - Fax:
Practice Address - Street 1:6701 FANNIN STREET
Practice Address - Street 2:SUITE D.0650.15
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-447-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48300207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery