Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH00003084 | WA |
NPI | 1811013311 |
---|---|
Provider Name | Dr. Thomas John Kelly |
First Address | Vancouver, WA 98682-3858 |
Second Address | Vancouver, WA 98682-3858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 09/07/2007 |