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NPI Code Detail

MEDICARE: TAMMAS F KELLY MD

MEDICARE:   TAMMAS F KELLY  MD
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
12084P0800XPsychiatry Physician30397CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1058853OTHERCOVALUE OPTIONS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710901418
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMAS F KELLY MD
Provider Business Mailing Address
First Line : 503 REMINGTON ST
Second Line : SUITE 210
City : FORT COLLINS
State : CO
Zip : 80524-3074
Country : US
Telephone Number : 970-484-5625
Fax Number : 970-493-5131
Provider Business Practice Location Address
First Line : 503 REMINGTON ST
Second Line : SUITE 210
City : FORT COLLINS
State : CO
Zip : 80524-3074
Country : US
Telephone Number : 970-484-5625
Fax Number : 970-493-5131
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 07/08/2007

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Directions to “ TAMMAS F KELLY MD” Practice Location

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