Provider Demographics
NPI:1891787693
Name:ROY, KELLY H (MD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:H
Last Name:ROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7330 N 16TH ST STE B101
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5274
Mailing Address - Country:US
Mailing Address - Phone:602-358-8588
Mailing Address - Fax:602-688-6991
Practice Address - Street 1:1008 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2603
Practice Address - Country:US
Practice Address - Phone:602-358-8588
Practice Address - Fax:602-688-6991
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28111207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ519556Medicaid
AZ7976320OtherAETNA
AZZ82292OtherMEDICARE ID - UNSPECIFIED
AZAZ0756830OtherBLUE CROSS BLUE SHIELD
AZAZ0756830OtherBLUE CROSS BLUE SHIELD
AZ519556Medicaid