Provider Demographics
NPI:1528490356
Name:KELLEY, DONALD HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HOWARD
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12637 MERRITT ESTES RD
Mailing Address - Street 2:
Mailing Address - City:DEADWOOD
Mailing Address - State:SD
Mailing Address - Zip Code:57732-7407
Mailing Address - Country:US
Mailing Address - Phone:605-578-3857
Mailing Address - Fax:
Practice Address - Street 1:12637 MERRITT ESTES RD
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:SD
Practice Address - Zip Code:57732-7407
Practice Address - Country:US
Practice Address - Phone:605-578-3857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0973207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology