Individual
TIMOTHY L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
732 SW 23RD ST, REDMOND, OR 97756-9400
(541) 548-7483
Mailing address
732 SW 23RD ST, REDMOND, OR 97756-9400
(541) 548-7483
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD00041959
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0197446
LABOR & IND
WA
05
—
213668
—
OR
05
—
8358756
—
WA
01
—
8905947
CRIME VICTIMS
WA
01
—
P00326179
RR MEDICARE
—
Enumeration date
08/23/2005
Last updated
11/08/2021
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