Provider Demographics
NPI:1588643894
Name:BETHARDS, KELBY F (MD)
Entity Type:Individual
Prefix:
First Name:KELBY
Middle Name:F
Last Name:BETHARDS
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 1:2127 E HARMONY RD
Mailing Address - Street 2:STE 140
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3406
Mailing Address - Country:US
Mailing Address - Phone:970-297-6250
Mailing Address - Fax:970-297-6260
Practice Address - Street 1:2127 E HARMONY RD
Practice Address - Street 2:STE 140
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3406
Practice Address - Country:US
Practice Address - Phone:970-297-6250
Practice Address - Fax:970-297-6260
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO39770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01783785Medicaid
COH85575Medicare UPIN
COCOAAA3367Medicare PIN