Provider Demographics
NPI:1174687560
Name:KELLEY, FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE # L4640
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-3099
Mailing Address - Country:US
Mailing Address - Phone:805-525-0215
Mailing Address - Fax:805-525-8031
Practice Address - Street 1:845 N 10TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-1348
Practice Address - Country:US
Practice Address - Phone:805-525-0215
Practice Address - Fax:805-525-8031
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71281207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71281Medicare UPIN