| Doctor Name: | RALPH KELLEY |
| NPI Number: | 1669589677 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 31361 |
| Business Practice Address: | 712 N Us Highway 61 Portageville, MO - 638731516 |
| Business Phone Number: | 5733793777 |
| Business Fax Number: | 5733793777 |
| Mailing Address: | 712 N Us Highway 61, PORTAGEVILLE |
| State: | MO |
| Postal Code: | 638731516 |
| Phone Number: | 5733793777 |
| Fax Number: | 5733793777 |
| NPI Enumeration Date: | 08/24/2006 |
| NPI Last Update Date: | 03/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 31361 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |