Individual
KYLE ANDERSON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1551 E TANGERINE RD, ORO VALLEY, AZ 85755-6213
(520) 901-3500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
75449
AZ
207L00000X
Anesthesiology Physician
N9575
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
305265601
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
8V5226
BCBS
TX
01
—
P01083623
RAIL ROAD
TX
Enumeration date
05/07/2008
Last updated
03/06/2025
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