Individual
JASON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 E HAMPDEN AVE, ENGLEWOOD, CO 80113-2702
(303) 761-9190
(303) 761-6322
Mailing address
10700 E GEDDES AVE, NO 200, ENGLEWOOD, CO 80112-3800
(303) 761-9190
(303) 761-6322
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
42731
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0257149
DEPT OF LABOR
WA
05
—
10025709000
—
NE
05
—
104705317
—
MI
05
—
1650324473/7729360
—
SD
05
—
1659324473
—
MT
05
—
1659324473
—
NV
05
—
1659324473
—
TX
05
—
1659324473
—
UT
05
—
1659324473
—
WY
05
—
200094308
—
MO
05
—
200418360A
—
KS
05
—
261632
—
AZ
05
—
38324041
—
CO
05
—
39230864
—
NM
05
—
84-059792913
—
NE
05
—
99111450
—
WI
01
—
P00141622
RR RIA MEDICARE
CO
01
—
P00760021
RR MCR MIC
CO
05
—
XPY202415
—
CA
Enumeration date
05/19/2006
Last updated
03/03/2015
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