Healthcare Provider Details

I. General information

NPI: 1831284306
Provider Name (Legal Business Name): ROBERT C KELSEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 US HIGHWAY 1 S STE B
ST AUGUSTINE FL
32086-6301
US

IV. Provider business mailing address

2720 US HIGHWAY 1 S STE B
ST AUGUSTINE FL
32086-6301
US

V. Phone/Fax

Practice location:
  • Phone: 904-827-0078
  • Fax: 904-827-0140
Mailing address:
  • Phone: 904-827-0078
  • Fax: 904-827-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME58662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: