Individual
NEIL R KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1730 MAIN ST, FORTUNA, CA 95540-2451
(707) 725-5223
(707) 725-2756
Mailing address
1730 MAIN ST, FORTUNA, CA 95540-2451
(707) 725-5223
(707) 725-2756
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000E23210
CA
213ER0200X
Radiology Podiatrist
000E23210
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
000E23210
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201857499
BLUE CROSS
CA
05
—
GRE001770
—
CA
01
—
ZZZ64278Z
BLUE SHIELD
CA
Enumeration date
07/11/2006
Last updated
03/27/2014
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