Kelly, Brian D

Kelly, Brian D is an individual health care provider with primary practice located at 1919 E Thomas Rd , Phoenix AZ 85016-7710. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Kelly, Brian D can be contacted via phone (602) 933-3033.

Contact Information

Primary practice address
1919 E Thomas Rd Phoenix AZ 85016-7710
Phone: (602) 933-3033
Fax: (602) 933-5245
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 50745 Arizona
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 258848 Massachusetts
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 50745 Arizona

Profile Details

NPI number 1053637736
LBN Legal business name Kelly, Brian D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 20th, 2010
Last updated Jan 11th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053637736 NPPES
Arizona MEDICAID 040502

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