Individual
DIANE J KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
ME47018
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042339400
—
FL
01
—
160045705
RR MEDICARE
FL
Enumeration date
11/02/2005
Last updated
04/09/2010
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