Provider Demographics
NPI:1881706752
Name:MYERS, KELLY J (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MYERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:5121 S COTTONWOOD STREET
Practice Address - Street 2:INTERMOUNTAIN MEDICAL CENTER
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84157
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-10-15
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Provider Licenses
StateLicense IDTaxonomies
UT94-276194-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2090168OtherUNITED HEALTHCARE
UT8597445OtherWORKERS COMP
UT310745OtherDESERET MUTUAL
UT44543OtherPEHP
UT7662OtherHEALTHY U
ID805588700Medicaid
UTQM0000075886OtherALTIUS
WY115800700Medicaid
UT1502954OtherUMWA
UT870545614MY1OtherEDUCATORS MUTUAL
UTPR01114OtherMOLINA
AZ833386Medicaid
NV002089140Medicaid
UT44543OtherPEHP
UT310745OtherDESERET MUTUAL
WY115800700Medicaid