Provider Demographics
NPI:1255351300
Name:WEAR, KELLEY D (MD)
Entity type:Individual
Prefix:DR
First Name:KELLEY
Middle Name:D
Last Name:WEAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLEY
Other - Middle Name:D
Other - Last Name:MAGGITTI WEAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16677 LOWELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8053
Mailing Address - Country:US
Mailing Address - Phone:303-957-7116
Mailing Address - Fax:
Practice Address - Street 1:16677 LOWELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8053
Practice Address - Country:US
Practice Address - Phone:303-957-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-44546174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR44545OtherMEDICAL LICENSE
COBW8537423OtherDEA NUMBER