MEDICARE: DR. THOMAS REYNOLDS KELLEY MD

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	207Q00000X	Family Medicine Physician	ME91713	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
2	ME91713	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1306833082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS REYNOLDS KELLEY MD

Provider Business Mailing Address
First Line	:	931 N SR 434 STE 1275
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7057
Country	:	US
Telephone Number	:	407-635-5516
Fax Number	:	407-636-7876

Provider Business Practice Location Address
First Line	:	931 N SR 434 STE 1275
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7057
Country	:	US
Telephone Number	:	407-635-5516
Fax Number	:	407-636-7876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	05/26/2020

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