Healthcare Provider Details

I. General information

NPI: 1659344000
Provider Name (Legal Business Name): JOE T KELLEY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 S BENEVA RD STE 201
SARASOTA FL
34232-2472
US

IV. Provider business mailing address

943 S BENEVA RD STE 201
SARASOTA FL
34232-2472
US

V. Phone/Fax

Practice location:
  • Phone: 941-366-3062
  • Fax: 941-957-1686
Mailing address:
  • Phone: 941-366-3062
  • Fax: 941-957-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME85515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: