MEDICARE: ROBERT BRUCE KILLEEN JR. M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME58217	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730570219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT BRUCE KILLEEN JR. M.D. P.A.

Provider Business Mailing Address
First Line	:	2520 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3846
Country	:	US
Telephone Number	:	727-945-0515
Fax Number	:	727-934-4045

Provider Business Practice Location Address
First Line	:	2520 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-3846
Country	:	US
Telephone Number	:	727-945-0515
Fax Number	:	727-934-4045

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT BRUCE KILLEEN JR.
Credential	:	M.D.
Telephone Number	:	727-945-0515

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	02/05/2015

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