Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0034098 | FL |
N | 208600000X | Surgeon | 0034098 | FL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME34098 | FL |
NPI | 1073519104 |
---|---|
Provider Name | Dr. Thomas F Kelly JR. |
First Address | Orlando, FL 32886-3407 |
Second Address | Sarasota, FL 34239-2930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 19/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008376100 | (05) | FL |
258121300 | (05) | FL |
68149 | BCBS (01) | FL |
D65709 | (02) | FL |