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Organization
WAYNE J KELLY MD
Active
Organization
WAYNE J KELLY MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE J KELLY MD (OWNER)
(951) 929-2753
Entity
Organization
Contact information
Practice address
301 E FLORIDA AVE STE E, HEMET, CA 92543-4253
(951) 929-2753
Mailing address
301 E FLORIDA AVE STE E, HEMET, CA 92543-4253
(951) 929-2753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0079650
—
CA
Enumeration date
02/19/2008
Last updated
09/23/2008
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