Provider Demographics
NPI:1205059169
Name:KELLY, STEPHEN J (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:KELLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1830 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4969
Mailing Address - Country:US
Mailing Address - Phone:205-933-2250
Mailing Address - Fax:205-933-2221
Practice Address - Street 1:1830 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4969
Practice Address - Country:US
Practice Address - Phone:205-933-2250
Practice Address - Fax:205-933-2221
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-08-24
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Provider Licenses
StateLicense IDTaxonomies
AL28419207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL46-1498286OtherIRS TAX ID