MEDICARE: WILLIAM R KELLEY JR. 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	2085R0202X	Diagnostic Radiology Physician	27770	AZ
2	2085R0202X	Diagnostic Radiology Physician	C51795	CA
3	2085R0202X	Diagnostic Radiology Physician	159835	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780666560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R KELLEY JR. MD

Provider Business Mailing Address
First Line	:	4825 HWY 95
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-8315
Country	:	US
Telephone Number	:	760-326-7225
Fax Number	:	760-326-8867

Provider Business Practice Location Address
First Line	:	9330 STATE ROAD 54
Second Line	:
City	:	TRINITY
State	:	FL
Zip	:	34655-1808
Country	:	US
Telephone Number	:	904-399-5800
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	05/22/2023

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Directions to “ WILLIAM R KELLEY JR. MD” Practice Location

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