Individual
BRIAN ROBERT KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7489 SUTHERLAND CIRCLE, BLDG 7489, FORT CARSON, CO 80913
(719) 526-4911
(719) 526-8883
Mailing address
7489 SUTHERLAND CIRCLE, BLDG 7489, FORT CARSON, CO 80913
(719) 526-8882
(719) 526-8883
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
R7037
TX
208100000X
Physical Medicine & Rehabilitation Physician
35.135837
OH
208100000X
Physical Medicine & Rehabilitation Physician
Primary
R7037
TX
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
35.135837
OH
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
R7037
TX
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
R7037
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0341279.
—
OH
Enumeration date
04/07/2015
Last updated
02/21/2024
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