Healthcare Provider Details

I. General information

NPI: 1669596201
Provider Name (Legal Business Name): FERNANDO A KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 S SEACREST BLVD SUITE 214
BOYNTON BEACH FL
33435-7501
US

IV. Provider business mailing address

2623 S SEACREST BLVD SUITE 214
BOYNTON BEACH FL
33435-7501
US

V. Phone/Fax

Practice location:
  • Phone: 561-731-2269
  • Fax: 531-731-2594
Mailing address:
  • Phone: 561-731-2269
  • Fax: 531-731-2594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME41684
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME41684
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME41684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: