Provider Demographics
NPI:1962508093
Name:KELLY, SCOTT MUNRO (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MUNRO
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1004 1ST ST N
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8766
Mailing Address - Country:US
Mailing Address - Phone:205-663-4638
Mailing Address - Fax:205-620-5209
Practice Address - Street 1:1004 1ST ST N
Practice Address - Street 2:SUITE 320
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8766
Practice Address - Country:US
Practice Address - Phone:205-663-4638
Practice Address - Fax:205-620-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL12520208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB98883Medicare UPIN
000060884Medicare ID - Type Unspecified