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General NPI Number Information
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NPI Number | 1023327673
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Entity Type | Organization
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Legal Business Name | PATRICK M.KELLEY, M.D., PLASTIC SURGERY CENTER, P.A.
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 15 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4520
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Country | US
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Telephone | 850-769-8991
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Fax | 850-769-3708
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Provider Business Mailing Address
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Address Line | 15 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4520
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Country | US
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Telephone | 850-769-8991
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Fax | 850-769-3708
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK MARK KELLEY
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Credential | M.D.
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Telephone | 850-769-8991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME0032802
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License Number State | FL
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