Provider Demographics
NPI:1659334126
Name:KELLEY, JEFFERY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOTT
Last Name:KELLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:14088 ALABAMA STREET
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1036
Mailing Address - Country:US
Mailing Address - Phone:850-675-4546
Mailing Address - Fax:850-675-4548
Practice Address - Street 1:14088 ALABAMA STREET
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1036
Practice Address - Country:US
Practice Address - Phone:850-675-4546
Practice Address - Fax:850-675-4548
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2012-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME81689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009952450OtherALACIAD
FL05101OtherHEALTH 1ST NETWORK, INC.
2239990OtherAARP HEALTHCARE UNITED
4071564OtherCIGNA
4071564OtherCIGNA HEALTHCARE PPO
7032394OtherAETNA CONTAINER
FLA611OtherWELLCARE
AL59063941OtherBCBS OF AL
FL593216460A06OtherMEDICAL MUTUAL
7032394OtherAETNA US HEALTHCARE
7032394OtherAETNA NABISCO
541009001OtherALACAID
7032394OtherAETNA
FLP00035820OtherRAILRAOD MEDICARE
FL1659334126OtherPYRAMID
4071564OtherCIGNA HEALTHCARE CO
FLP00017883OtherRAILROAD MEDICARE
FL05101OtherPREFERRED PATIENT CARE
FL2239990OtherUNITED HEALTHCARE OF FLORIDA
FL071981OtherVISTA
593216460OtherBEECH STREET
05101OtherBLUE CROSS BLUE SHIELD
FL21333OtherBLUE MEDICARE ADVANTAGE
FL261059100Medicaid
7032394OtherAETNA LIFE INS CO
7032394OtherATENA GLOBAL BENEFITS
2239990OtherUNITED HEALTHCARE
7032394OtherAETNA LIFE & CASUALTY
7032394OtherAETNA LIFE & CASUALTY
FLP00017883OtherRAILROAD MEDICARE
7032394OtherAETNA LIFE INS CO