Individual
JEFFREY SCOTT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
26281
NC
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
26281
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467496422
—
VA
01
—
146FE
BCBS
NC
01
—
202034
MEDCOST
NC
01
—
810633
PARTNERS
NC
05
—
8948222
—
NC
01
—
9265070
AETNA
—
Enumeration date
12/13/2005
Last updated
12/07/2010
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