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NPI Code Detail

MEDICARE: BRIAN CHRISTOPHER KELLEY D.O.

MEDICARE: BRIAN CHRISTOPHER KELLEY D.O.
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
1207T00000XNeurological Surgery Physician94-06814KS
2207T00000XNeurological Surgery PhysicianDO.000318LA

General Provider Information

NPI Number : 1750587838
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN CHRISTOPHER KELLEY D.O.
Provider Business Mailing Address
First Line : 1614 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2348
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Provider Business Practice Location Address
First Line : 1614 WOLF CIR
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70605-2348
Country : US
Telephone Number : 337-478-9653
Fax Number : 337-474-0988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2007
Last Update Date : 06/14/2013

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