Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | E0847 | AR |
NPI | 1144289331 |
---|---|
Provider Name | Dr. James E. Kelly III |
First Address | Fort Smith, AR 72917-0810 |
Second Address | Fort Smith, AR 72916-6056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100000480A | (05) | OK |
130121001 | (05) | AR |
G18935 | (02) | AR |