KELLY FOUNTAIN

MELBOURNE, FL
NPI1700016359
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy2085R0202X Radiology, Diagnostic Radiology
(Licence: FL  ME 129581)
Additional Taxonomies2085R0202X Radiology, Diagnostic Radiology
(Licence: MS  23930)
2085R0202X Radiology, Diagnostic Radiology
(Licence: AL  30719)
2085R0202X Radiology, Diagnostic Radiology
(Licence: CO  DR.0057830)
2085R0202X Radiology, Diagnostic Radiology
(Licence: KS  04-37158)
Enumeration Date2009-07-16
Last Update Date2020-05-10
Business Address
KELLY FOUNTAIN M.D.
1223 GATEWAY DR
MELBOURNE, FL 32901-2607
Phone number: 321-728-6002
Mailing Address
KELLY FOUNTAIN M.D.
4020 TURKEY POINT DR
MELBOURNE, FL 32934-8584
Phone number: 251-363-1745