Individual
MR. BRIAN WILBUR KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD10756
OR
207RP1001X
Pulmonary Disease Physician
MD10756
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003293001
BCBS
OR
05
—
227538
—
OR
01
—
C9123100001
PROVIDENCE
OR
01
—
DG4207
RAILROAD MEDICARE GROUP #
OR
Enumeration date
09/12/2006
Last updated
01/14/2015
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