Individual
DR. KELLY JOE KRIZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3417 ENSIGN RD NE, OLYMPIA, WA 98506-5064
(360) 493-4600
(360) 493-4603
Mailing address
3417 ENSIGN RD NE, OLYMPIA, WA 98506-5064
(360) 493-4600
(360) 493-4603
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD00024212
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207097
—
OR
01
—
5995KR
REGENCE BLUE SHIELD
WA
05
—
807397800
—
ID
05
—
8450025
—
WA
Enumeration date
04/05/2006
Last updated
10/15/2010
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