Individual
JASON KELLY
Active
Individual
JASON KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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