Kelly, Lawrence J

Kelly, Lawrence J is an individual health care provider with primary practice located at 12361 W Bola Dr Suite 100, Surprise AZ 85378-9021. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Kelly, Lawrence J can be contacted via phone (623) 584-5626.

Contact Information

Primary practice address
12361 W Bola Dr Suite 100 Surprise AZ 85378-9021
Phone: (623) 584-5626
Fax: (623) 584-8998
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 27172 Arizona
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 35083 Arizona

Profile Details

NPI number 1124014758
LBN Legal business name Kelly, Lawrence J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated Jun 6th, 2016 - about 9 years 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 1124014758 NPPES
Arizona Other 5920416 AETNA
Arizona Other P00188666 AETNA
Arizona Other 2036792 AETNA
Arizona Other 2Z1651 AETNA
Arizona Other 1124014758 AETNA
Arizona Other P0836100 AETNA
Arizona MEDICAID 514829 AETNA

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