Individual
DOUGLAS WAYNE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5501 N 19TH AVE, 432, PHOENIX, AZ 85015-2450
(602) 242-7691
(602) 242-7265
Mailing address
5501 N 19TH AVE, 432, PHOENIX, AZ 85015-2450
(602) 242-7691
(602) 242-7265
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
12896
AZ
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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