Individual
RALPH KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
314 E MAIN ST, PORTAGEVILLE, MO 63873-1616
(573) 379-3777
Mailing address
314 E MAIN ST, PORTAGEVILLE, MO 63873-1616
(573) 379-3777
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
31361
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241143213
—
MO
Enumeration date
08/24/2006
Last updated
12/20/2016
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