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Contact Information

KELLY J ANDERSON, MD
3430 WASHINGTON PKWY
IDAHO FALLS, ID83404-7579
 Phone: 208-523-3060
 Fax: 208-523-0028
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for KELLY J ANDERSON · (Male)

NPI # 1194935049
Status Active
Credentials MD
Entity Individual
Enumeration date 05/22/2007
Last updated 09/10/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M10579
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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