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General NPI Number Information
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NPI Number | 1497716781
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Entity Type | Individual
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Provider Name | DOUGLAS A KELLY MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 2700 DOLBEER ST
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City | EUREKA
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State | CA
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Zip | 95501-4736
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Country | US
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Telephone | 707-269-4229
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Fax | 707-269-3849
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Provider Business Mailing Address
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Address Line | 154 APPLE VALLEY LN
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City | EUREKA
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State | CA
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Zip | 95503-9546
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Country | US
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Telephone | 918-269-6936
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 19729
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | DR0062949
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | C193918
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License Number State | CA
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