Individual
JASON KELLY
Active
Individual
JASON KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT. RVS
Taxonomy
Speciality
Code
Description
License number
State
246XS1301X
Sonography Specialist/Technologist Cardiovascular
Primary
00096509
AZ
247100000X
Radiologic Technologist
CRT-11630
AZ
Other
Enumeration date
08/16/2016
Last updated
08/16/2016
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