Provider Demographics
NPI:1366430241
Name:MOORE, KELLY L (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:MOORE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-320-8499
Mailing Address - Fax:303-320-8620
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3912
Practice Address - Country:US
Practice Address - Phone:303-320-8499
Practice Address - Fax:303-320-8620
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-02-08
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Provider Licenses
StateLicense IDTaxonomies
CO40114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201073340AMedicaid
CO00820041Medicaid
CO00820041Medicaid
COP00629586Medicare PIN
CO807683Medicare PIN