Individual
DR. ROBERT B KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
665 WINTER ST SE, SALEM, OR 97301-3919
(503) 561-5634
Mailing address
PO BOX 2505, SALEM, OR 97308-2505
(888) 828-3198
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD 20525
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150504
MARION POLK CHP
—
05
—
150504
—
OR
05
—
8209959
—
WA
01
—
A056
CHAMPUS
—
01
—
G53960
PROVIDENCE
—
01
—
M400721
PACIFIC SOURCE
—
Enumeration date
09/19/2006
Last updated
12/04/2007
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