Individual
MR. DONALD R KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2121 E HARMONY RD, STE 330, FORT COLLINS, CO 80528-3400
(970) 221-5878
(970) 221-3564
Mailing address
2121 E HARMONY RD, STE 330, FORT COLLINS, CO 80528-3400
(970) 221-5878
(970) 221-3564
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0000747
CO
363AS0400X
Surgical Physician Assistant
747
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07007479
—
CO
01
—
P01052988
RR MEDICARE
CO
Enumeration date
03/20/2006
Last updated
12/26/2014
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