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Individual
DR. LEROY J KELLEY III
Active
Individual
DR. LEROY J KELLEY III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1496
MA
213ES0131X
Foot Surgery Podiatrist
1496
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0335797
—
MA
01
—
042715679
TAX ID
MA
01
—
1496
STATE ID
MA
01
—
LXO122
PTAN
MA
01
—
V09521
UPIN
MA
01
—
Y70632
BC/BS
MA
Enumeration date
11/08/2005
Last updated
12/01/2020
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