Individual
DR. ROBERT R 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
665 WINTER ST SE, SALEM, OR 97301-3919
(888) 828-3198
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD10660
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116863
MARION POLK CHP
—
05
—
116863
—
OR
01
—
185702
L & I
WA
05
—
8443129
—
WA
01
—
A052
CHAMPUS
—
01
—
C91106
PROVIDENCE
—
05
—
XPY049930
—
CA
Enumeration date
09/19/2006
Last updated
12/19/2007
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