Provider Demographics
NPI:1194733402
Name:KELLEY, STEVEN THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:THOMAS
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:40949 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6031
Mailing Address - Country:US
Mailing Address - Phone:951-296-6676
Mailing Address - Fax:951-296-6675
Practice Address - Street 1:40949 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6031
Practice Address - Country:US
Practice Address - Phone:951-296-6676
Practice Address - Fax:951-296-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78913207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine