Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 35073401 | OH |
NPI | 1003811407 |
---|---|
Provider Name | Brian Kelley |
First Address | Dublin, OH 43016-6102 |
Second Address | Dublin, OH 43016-8518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 05/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2171626 | (05) | OH |