Individual
JASON KELLY
Active
Individual
JASON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
Update your record
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