Individual
JASON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
Mailing address
1901 CONNECTICUT AVE S, SARTELL, MN 56377-2554
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
58081
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58081
STATE BOARD
MN
Enumeration date
07/20/2010
Last updated
05/01/2018
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