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Organization
KELLY MEDICAL, PC
Active
Organization
KELLY MEDICAL, PC
Active
Other names
Kelly Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN BLAKE KELLY MD (DOCTOR)
(405) 752-9600
Entity
Organization
Contact information
Practice address
13921 N MERIDIAN AVE STE 100, OKLAHOMA CITY, OK 73134-1106
(405) 752-9600
(405) 752-9650
Mailing address
PO BOX 268938, OKLAHOMA CITY, OK 73126-8938
(405) 752-9600
(405) 752-9650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
NULL
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
NULL
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Enumeration date
06/13/2006
Last updated
10/31/2019
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