Provider Demographics
NPI:1659385821
Name:KELLAR, JEFFREY D (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:KELLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1710 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7303
Mailing Address - Country:US
Mailing Address - Phone:870-698-1846
Mailing Address - Fax:870-793-2463
Practice Address - Street 1:501 VIRGINIA DR STE C
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7317
Practice Address - Country:US
Practice Address - Phone:870-698-1846
Practice Address - Fax:870-793-2463
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3076208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR621872OtherHEALTHLINK
AR7402386OtherAETNA
AR146697001Medicaid
AR1077000000OtherQUALCHOICE
OK100075350AMedicaid
MO205755002Medicaid
ARH58537Medicare UPIN
OK100075350AMedicaid