Individual
MARK EDWARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 COLUMBIA DR, TAMPA, FL 33606-3508
(813) 844-4396
(813) 844-4972
Mailing address
2 COLUMBIA DR, TAMPA, FL 33606-3508
(813) 844-4396
(813) 844-4972
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME82914
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03171
FL BCBS NUMBER
FL
01
—
050083047
MEDICARE RAILROAD
FL
05
—
262154100
—
FL
01
—
300802800
DOL ACS (FECA) W/C
FL
Enumeration date
05/19/2006
Last updated
03/11/2008
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