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NPI Code Detail

MEDICARE: BRIAN D. KELLY D.O.

MEDICARE: BRIAN D. KELLY 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
1207RC0000XCardiovascular Disease PhysicianOS0005851FL

General Provider Information

NPI Number : 1811985112
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN D. KELLY D.O.
Provider Business Mailing Address
First Line : 777 AVENUE H
Second Line :
City : POWELL
State : WY
Zip : 82435-2260
Country : US
Telephone Number : 307-754-2267
Fax Number : 307-754-7217
Provider Business Practice Location Address
First Line : 777 AVENUE H
Second Line :
City : POWELL
State : WY
Zip : 82435-2260
Country : US
Telephone Number : 307-754-2267
Fax Number : 307-754-7217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 11/06/2020

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