Provider Demographics
NPI:1023009123
Name:KELLS, DAVID NORRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NORRIS
Last Name:KELLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 S DOBSON RD
Mailing Address - Street 2:SUITE A101
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5667
Mailing Address - Country:US
Mailing Address - Phone:480-855-5900
Mailing Address - Fax:480-855-9171
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:SUITE A101
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-855-5900
Practice Address - Fax:480-855-9171
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ216409Medicaid
Z137732OtherPTAN
AZ24119Medicare ID - Type Unspecified
AZD37124Medicare UPIN