Healthcare Provider Details

I. General information

NPI: 1487689857
Provider Name (Legal Business Name): RONALD W KELLER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 53
MEMPHIS MO
63555-9767
US

IV. Provider business mailing address

RR 1 BOX 132
MEMPHIS MO
63555-9766
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-8511
  • Fax: 660-465-8511
Mailing address:
  • Phone: 660-945-3972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR4C33
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: