Provider Demographics
NPI:1205149937
Name:CONNOLLY, KERA MARIE (DO)
Entity type:Individual
Prefix:
First Name:KERA
Middle Name:MARIE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:1B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-581-4848
Mailing Address - Fax:727-584-7429
Practice Address - Street 1:2 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3201
Practice Address - Country:US
Practice Address - Phone:727-449-2224
Practice Address - Fax:727-441-4107
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 11581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHJ432ZMedicare PIN