KELLY, JASON (MD)

Provider Demographics

• NPI: 1659324473
• Name: KELLY, JASON (MD)
• Entity Type: Individual
• First Name: JASON
• Last Name: KELLY
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: 10700 E GEDDES AVE
• Mailing Address - Street 2: NO 200
• Mailing Address - City: ENGLEWOOD
• Mailing Address - State: CO
• Mailing Address - Zip Code: 80112-3800
• Mailing Address - Country: US
• Mailing Address - Phone: 303-761-9190
• Mailing Address - Fax: 303-761-6322
• Practice Address - Street 1: 501 E HAMPDEN AVE
• Practice Address - City: ENGLEWOOD
• Practice Address - State: CO
• Practice Address - Zip Code: 80113-2702
• Practice Address - Country: US
• Practice Address - Phone: 303-761-9190
• Practice Address - Fax: 303-761-6322
• Is Sole Proprietor?: No
• Enumeration Date: 2006-05-19
• Last Update Date: 2015-03-03

Provider Licenses

State	License ID	Taxonomies
CO	42731	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WY	1659324473	Medicaid
NV	1659324473	Medicaid
MO	200094308	Medicaid
WA	0257149	Other	DEPT OF LABOR
MI	104705317	Medicaid
SD	1650324473/7729360	Medicaid
NM	39230864	Medicaid
CO	P00760021	Other	RR MCR MIC
UT	1659324473	Medicaid
CA	XPY202415	Medicaid
MT	1659324473	Medicaid
CO	P00141622	Other	RR RIA MEDICARE
NE	10025709000	Medicaid
TX	1659324473	Medicaid
KS	200418360A	Medicaid
WI	99111450	Medicaid
AZ	261632	Medicaid
CO	38324041	Medicaid
NE	84-059792913	Medicaid
NE	10025709000	Medicaid
WY	1659324473	Medicaid
CO	CO304407	Medicare PIN
WA	0257149	Other	DEPT OF LABOR
TX	1659324473	Medicaid
MT	1659324473	Medicaid
OH	$$$$$$$$$-00	Medicaid
WY	1659324473	Medicaid
MO	200094308	Medicaid
KS	KA3249007	Medicare PIN
NE	NA1215028	Medicare PIN
WI	99111450	Medicaid
CO	C529258	Medicare PIN
NE	NA2517010	Medicare PIN