Healthcare Provider Details

I. General information

NPI: 1699961474
Provider Name (Legal Business Name): GREGORY S KELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 DE LA VINA ST
SANTA BARBARA CA
93105-3873
US

IV. Provider business mailing address

2305 DE LA VINA ST
SANTA BARBARA CA
93105-3873
US

V. Phone/Fax

Practice location:
  • Phone: 805-687-6408
  • Fax: 805-563-7750
Mailing address:
  • Phone: 805-687-6408
  • Fax: 805-563-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number22919
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG22919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: