Provider Demographics
NPI:1861541005
Name:KELTS, ERIC ALAN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:KELTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E ARAPAHOE RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1279
Mailing Address - Country:US
Mailing Address - Phone:303-284-7950
Mailing Address - Fax:720-542-9930
Practice Address - Street 1:7400 E ARAPAHOE RD
Practice Address - Street 2:STE. 100
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1279
Practice Address - Country:US
Practice Address - Phone:303-284-7950
Practice Address - Fax:720-542-9930
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD56742084N0400X
CO438562084N0400X
NY215819-12084N0400X
NMMD2013-07862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ024437Medicaid
SD460403740OtherTRICARE
SD4994386OtherBC BS
SD6100970Medicaid
WY123280100Medicaid
CO53839731Medicaid
SD460403740OtherTRICARE
SD6100970Medicaid
100448Medicare PIN