Provider Demographics
NPI:1659344000
Name:KELLEY, JOE T III (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:T
Last Name:KELLEY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 S BENEVA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2472
Mailing Address - Country:US
Mailing Address - Phone:941-366-3062
Mailing Address - Fax:941-957-1686
Practice Address - Street 1:943 S BENEVA RD STE 201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2472
Practice Address - Country:US
Practice Address - Phone:941-366-3062
Practice Address - Fax:941-957-1686
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85515207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17086ZMedicare PIN
H63880Medicare UPIN