Provider Demographics
NPI:1386698066
Name:KELLY, JAMES B JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 504407
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4407
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:CARDIOTHORACIC ANESTHESIA DEPT
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:816-932-7940
Practice Address - Fax:816-932-7957
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-12-13
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Provider Licenses
StateLicense IDTaxonomies
MO100504207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000331OtherMO FHP PROVIDER NUMBER
MO100132430CMedicaid
MO18270092OtherMO BCBS PROVIDER NUMBER
MO203317052Medicaid
MO050088896OtherMO RR MEDICARE NUMBER
MO050088896OtherMO RR MEDICARE NUMBER
MOE23382Medicare UPIN