Kelly, David J

Kelly, David J is an individual health care provider with primary practice located at 3217 W Bavaria St , Eagle ID 83616-5171. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Kelly, David J can be contacted via phone (208) 302-6200.

Contact Information

Primary practice address
3217 W Bavaria St Eagle ID 83616-5171
Phone: (208) 302-6200
Fax: (208) 302-6255
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD155014 Oregon
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-17694 Idaho
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 47273 Wisconsin
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-9938 Idaho

Profile Details

NPI number 1194862417
LBN Legal business name Kelly, David J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2007
Last updated Apr 4th, 2024 - about 7 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194862417 NPPES
Idaho MEDICAID 807768800

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