Individual
GARY A KELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
(417) 875-3409
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
33486
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107060
BLUE CROSS/BLUE SHIELD
—
05
—
200404804
—
MO
Enumeration date
06/14/2006
Last updated
07/03/2012
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