Healthcare Provider Details

I. General information

NPI: 1447176540
Provider Name (Legal Business Name): DR. KEATON TABER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 680S
CHESTERFIELD MO
63017-3477
US

IV. Provider business mailing address

17026 OLD HOLLOW DR
WILDWOOD MO
63040-1144
US

V. Phone/Fax

Practice location:
  • Phone: 314-864-3203
  • Fax:
Mailing address:
  • Phone: 417-437-7916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026028859
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: