Provider Demographics
NPI:1265545834
Name:KELL, DAVID R (MD, PM&R)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:KELL
Suffix:
Gender:M
Credentials:MD, PM&R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-0831
Mailing Address - Country:US
Mailing Address - Phone:415-491-1210
Mailing Address - Fax:415-491-4647
Practice Address - Street 1:900 HYDE STREET
Practice Address - Street 2:CENTER FOR SPORTS MEDICINE
Practice Address - City:SAN FRANCSICO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-927-1900
Practice Address - Fax:415-491-4647
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048122171100000X, 225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF76687Medicare UPIN
CA00A481220Medicare ID - Type UnspecifiedPHYSICATRIST