Individual
DAVID J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3217 W BAVARIA ST, EAGLE, ID 83616-5171
(208) 302-6200
(208) 302-6255
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
47273
WI
207Q00000X
Family Medicine Physician
Primary
M-17694
ID
207Q00000X
Family Medicine Physician
M-9938
ID
207Q00000X
Family Medicine Physician
MD155014
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807768800
—
ID
Enumeration date
01/30/2007
Last updated
04/04/2024
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