Individual
JOHN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1402 S GRAND BLVD, SAINT LOUIS, MO 63104-1004
(314) 977-9853
Mailing address
1402 S GRAND BLVD, SAINT LOUIS, MO 63104-1004
(314) 977-9853
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD048478
DC
207L00000X
Anesthesiology Physician
Primary
ME158542
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2016
Last updated
12/05/2022
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