Kelly, Robert R

Kelly, Robert R is an individual health care provider with primary practice located at 665 Winter St Se , Salem OR 97301-3919. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kelly, Robert R can be contacted via phone (503) 561-5634.

Contact Information

Primary practice address
665 Winter St Se Salem OR 97301-3919
Phone: (503) 561-5634
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD10660 Oregon

Profile Details

NPI number 1841397445
LBN Legal business name Kelly, Robert R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2006
Last updated Dec 19th, 2007 - about 17 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 1841397445 NPPES
Washington MEDICAID 8443129
Washington Other A052
Washington MEDICAID XPY049930
Washington MEDICAID 116863
Washington Other C91106
Washington Other C91106
Washington Other 116863
Washington Other 185702

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