Provider Demographics
NPI:1841705100
Name:KTD, PLLC
Entity type:Organization
Organization Name:KTD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-965-5888
Mailing Address - Street 1:2216 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3838
Mailing Address - Country:US
Mailing Address - Phone:254-965-5888
Mailing Address - Fax:254-965-5865
Practice Address - Street 1:2216 W WASHINGTON
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-7640
Practice Address - Country:US
Practice Address - Phone:254-965-5888
Practice Address - Fax:254-965-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care