Provider Demographics
NPI:1831284306
Name:KELSEY, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:KELSEY
Suffix:
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 1:2720 US HIGHWAY 1 S
Mailing Address - Street 2:STE B
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6301
Mailing Address - Country:US
Mailing Address - Phone:904-827-0078
Mailing Address - Fax:904-827-0140
Practice Address - Street 1:2720 US HIGHWAY 1 S
Practice Address - Street 2:STE B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6301
Practice Address - Country:US
Practice Address - Phone:904-827-0078
Practice Address - Fax:904-827-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58662207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377818500Medicaid
FLP00157250OtherRAILROAD MEDICARE
FL377818500Medicaid
FL26812WMedicare PIN