Provider Demographics
NPI:1962403311
Name:REBER, KELLY (DPM)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:
Last Name:REBER
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:940 N SWITZER CANYON DR
Mailing Address - Street 2:STE #102
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4852
Mailing Address - Country:US
Mailing Address - Phone:928-779-5111
Mailing Address - Fax:928-779-1374
Practice Address - Street 1:940 N SWITZER CANYON DR
Practice Address - Street 2:STE #102
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4852
Practice Address - Country:US
Practice Address - Phone:928-779-5111
Practice Address - Fax:928-779-1374
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-02-18
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Provider Licenses
StateLicense IDTaxonomies
AZ0195213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1028440001Medicare NSC
U77787Medicare UPIN