Provider Demographics
NPI:1871885202
Name:KRIS M BLY MEDICAL SERVICES P.A.
Entity type:Organization
Organization Name:KRIS M BLY MEDICAL SERVICES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-509-1447
Mailing Address - Street 1:13 EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6244
Mailing Address - Country:US
Mailing Address - Phone:305-735-3920
Mailing Address - Fax:305-328-8304
Practice Address - Street 1:3420 DUCK AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4427
Practice Address - Country:US
Practice Address - Phone:305-296-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10451207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty