Provider Demographics
NPI:1174900914
Name:KELLY, BLANE JR (MD)
Entity type:Individual
Prefix:
First Name:BLANE
Middle Name:
Last Name:KELLY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14601 HOPE CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4707
Mailing Address - Country:US
Mailing Address - Phone:239-461-6321
Mailing Address - Fax:
Practice Address - Street 1:14601 HOPE CENTER LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4707
Practice Address - Country:US
Practice Address - Phone:239-334-7000
Practice Address - Fax:239-334-7070
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME149155207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery