Healthcare Provider Details

I. General information

NPI: 1982798740
Provider Name (Legal Business Name): ROBERT C KELSEY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD SUITE 107
ST AUGUSTINE FL
32086-5796
US

IV. Provider business mailing address

PO BOX 3350
ST AUGUSTINE FL
32085-3350
US

V. Phone/Fax

Practice location:
  • Phone: 904-827-0078
  • Fax: 904-827-0078
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT C KELSEY
Title or Position: OWNER
Credential: MD
Phone: 904-827-0078