Provider Demographics
NPI:1356308290
Name:KELLEY, SEAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:F
Last Name:KELLEY
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:PO BOX 26706
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-0706
Mailing Address - Country:US
Mailing Address - Phone:405-775-9350
Mailing Address - Fax:405-775-9360
Practice Address - Street 1:4317 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73134-1720
Practice Address - Country:US
Practice Address - Phone:405-775-9350
Practice Address - Fax:405-775-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16228207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100090310BMedicaid
OKP00372726OtherRR MEDICARE
OK100090310BMedicaid
OK$$$$$$$$$002OtherBC/BS
OKP00372726OtherRR MEDICARE