Healthcare Provider Details

I. General information

NPI: 1548273014
Provider Name (Legal Business Name): ALBERT R KELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 29TH ST SUITE 109
OAKLAND CA
94609-3519
US

IV. Provider business mailing address

PO BOX 282848
SAN FRANCISCO CA
94128-2848
US

V. Phone/Fax

Practice location:
  • Phone: 510-663-6204
  • Fax:
Mailing address:
  • Phone: 650-616-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberG12937
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberG12937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: