Provider Demographics
NPI:1750615993
Name:O'MALLEY-KEYES, JULIA MEGAN (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:MEGAN
Last Name:O'MALLEY-KEYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 SE 110TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-3118
Mailing Address - Country:US
Mailing Address - Phone:352-233-2360
Mailing Address - Fax:352-233-2363
Practice Address - Street 1:4850 SE 110TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-3118
Practice Address - Country:US
Practice Address - Phone:352-233-2360
Practice Address - Fax:352-233-2363
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102993207Q00000X, 207QA0505X
SCMD27968207QA0505X
CT050560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I46743Medicare UPIN
FLCV263Medicare PIN