Provider Demographics
NPI:1093126427
Name:KELLEY, ROBERT T (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:KELLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4650 SIGNAL TREE DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-4908
Mailing Address - Country:US
Mailing Address - Phone:970-237-7415
Mailing Address - Fax:970-237-7420
Practice Address - Street 1:4650 SIGNAL TREE DR STE 1200
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4908
Practice Address - Country:US
Practice Address - Phone:970-237-7415
Practice Address - Fax:970-237-7420
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL0005132207Q00000X
CODR.0055887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000175262Medicaid