Provider Demographics
NPI:1083057525
Name:KELLY, ISAAC LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:LAURENCE
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1175 E ARROW HWY STE E
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5525
Mailing Address - Country:US
Mailing Address - Phone:909-985-9737
Mailing Address - Fax:909-981-1203
Practice Address - Street 1:1175 E ARROW HWY STE E
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-985-9737
Practice Address - Fax:909-981-1203
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2019-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA134284208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology