Provider Demographics
NPI:1083899108
Name:PETER P OKELLY MD PA FLOR
Entity Type:Organization
Organization Name:PETER P OKELLY MD PA FLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-674-2125
Mailing Address - Street 1:PO BOX 14107
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-4107
Mailing Address - Country:US
Mailing Address - Phone:843-674-2125
Mailing Address - Fax:843-674-2128
Practice Address - Street 1:805 PAMPLICO HWY STE B125
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6049
Practice Address - Country:US
Practice Address - Phone:843-674-2125
Practice Address - Fax:843-674-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7765Medicare PIN