Individual
KELLY L ALEXANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1199 BUSH ST STE 400, SAN FRANCISCO, CA 94109-5975
(415) 379-2890
(415) 349-6025
Mailing address
3400 DATA DR, ATTN: CREDENTIALING/PAYER ENROLLMENT, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C162278
CA
Other
Enumeration date
06/23/2006
Last updated
09/29/2020
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