Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A29089 | CA |
NPI | 1033467543 |
---|---|
Provider Name | Dr. Donald Kaempfer Kelly |
First Address | Bainbridge Island, WA 98110-1088 |
Second Address | Bainbridge Island, WA 98110-1088 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2012 |
Last Update Date | 15/08/2012 |