Individual
KELLY C PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
203 S DAISY ST, SALMON, ID 83467-0000
(208) 756-5600
(208) 756-4169
Mailing address
203 S DAISY ST, SALMON, ID 83467-0000
(208) 756-5600
(208) 756-4169
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
M-5808
ID
207Q00000X
Family Medicine Physician
Primary
M5808
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004220800
—
ID
Enumeration date
10/17/2006
Last updated
02/04/2019
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