Individual
MR. BRIAN WILBUR KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 SE OAK ST, SUITE F, HILLSBORO, OR 97123-4147
(503) 640-5950
(503) 648-3140
Mailing address
545 SE OAK ST, SUITE F, HILLSBORO, OR 97123-4147
(503) 640-5950
(503) 648-3140
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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