Kelly, Thomas J

Kelly, Thomas J is an individual health care provider with primary practice located at 1000 Mar Walt Dr , Fort Walton Beach FL 32547-6708. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Kelly, Thomas J can be contacted via phone (850) 863-7607.

Contact Information

Primary practice address
1000 Mar Walt Dr Fort Walton Beach FL 32547-6708
Phone: (850) 863-7607
Fax: (205) 437-5998
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X OS6762 Florida

Profile Details

NPI number 1629026596
LBN Legal business name Kelly, Thomas J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2006
Last updated Mar 20th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629026596 NPPES
Florida Other 80923 BCBS PROVIDER NUMBER
Florida MEDICAID 376379000 BCBS PROVIDER NUMBER
Florida Other 059185641 BCBS PROVIDER NUMBER
Florida Other 059190499 BCBS PROVIDER NUMBER

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