Individual
MARK EDWARD KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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