Provider Demographics
NPI:1306834833
Name:KELLY, ALAN J (MD)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:J
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1215 N MCDONALD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1557
Mailing Address - Country:US
Mailing Address - Phone:509-924-1950
Mailing Address - Fax:509-921-0017
Practice Address - Street 1:1215 N MCDONALD RD
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1557
Practice Address - Country:US
Practice Address - Phone:509-924-1950
Practice Address - Fax:509-921-0017
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2017-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WABC60304772207R00000X
ORMD21000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR151073Medicaid
G67357Medicare UPIN
132304Medicare ID - Type Unspecified