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General NPI Number Information
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NPI Number | 1205866811
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Entity Type | Individual
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Provider Name | JON P KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 01/17/2011
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Provider Practice Location Address
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Address Line | 2777 JEFFERSON ST SUITE 100
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City | CARLSBAD
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State | CA
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Zip | 92008-1743
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Country | US
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Telephone | 760-434-0033
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Fax | 760-434-0027
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Provider Business Mailing Address
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Address Line | PO BOX 390005
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City | SAN DIEGO
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State | CA
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Zip | 92149-0005
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Country | US
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Telephone | 619-746-6530
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Fax | 619-746-6528
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A45013
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | A45013
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License Number State | CA
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