Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 27172 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35083 | AZ |
NPI | 1124014758 |
---|---|
Provider Name | Lawrence J Kelly |
First Address | Surprise, AZ 85378-9021 |
Second Address | Surprise, AZ 85378-9021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 06/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124014758 | AHCCCS (01) | AZ |
2036792 | UNITED HEALTHCARE (01) | AZ |
2Z1651 | HEALTHNET (01) | AZ |
514829 | (05) | AZ |
5920416 | AETNA (01) | AZ |
G27850 | (02) | |
P00188666 | RAILROAD MEDICARE (01) | AZ |
P0836100 | BCBS OUT OF AREA (01) | AZ |