Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 0103000746 | VA |
NPI | 1114907458 |
---|---|
Provider Name | Dr. Peter F Kelly |
First Address | Roanoke, VA 24018-0057 |
Second Address | Roanoke, VA 24014-2814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T21343 | (02) | VA |