Individual
DR. KELLY RAY MUTCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
62462 IGO LN, LA GRANDE, OR 97850-5147
(541) 963-9732
Mailing address
62462 IGO LN, LA GRANDE, OR 97850-5147
(541) 963-9732
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15980
OR
207R00000X
Internal Medicine Physician
M-4837
ID
Other
Enumeration date
03/23/2009
Last updated
03/23/2009
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