Connelly, Kevin Gerard

Connelly, Kevin Gerard is an individual health care provider with primary practice located at 1201 Fairmount Ave , Fort Worth TX 76104-4215. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Connelly, Kevin Gerard can be contacted via phone (817) 335-5288.

Contact Information

Primary practice address
1201 Fairmount Ave Fort Worth TX 76104-4215
Phone: (817) 335-5288
Fax: (817) 338-0927
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X H7600 Texas
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X H7600 Texas

Profile Details

NPI number 1417943713
LBN Legal business name Connelly, Kevin Gerard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2005
Last updated Jan 10th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417943713 NPPES
Texas MEDICAID 036910001

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