Healthcare Provider Details

I. General information

NPI: 1760825566
Provider Name (Legal Business Name): DUKE KELLER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DAVID KELLER D.O

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6644 E BAYWOOD AVE
MESA AZ
85206-1747
US

IV. Provider business mailing address

4720 E CLARENDON AVE
PHOENIX AZ
85018-6016
US

V. Phone/Fax

Practice location:
  • Phone: 480-321-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSH848782
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5315066555
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number007356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: