Provider Demographics
NPI:1932145976
Name:KELLEY, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
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 1:247 N FIREWEED
Mailing Address - Street 2:STE A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7593
Mailing Address - Country:US
Mailing Address - Phone:907-262-8597
Mailing Address - Fax:907-262-6516
Practice Address - Street 1:247 N FIREWEED ST STE A
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7593
Practice Address - Country:US
Practice Address - Phone:907-262-8597
Practice Address - Fax:907-262-6516
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0006Medicaid
F05824Medicare UPIN
AK0972210001Medicare NSC
AKMD0006Medicaid
AK110089465Medicare PIN