Healthcare Provider Details

I. General information

NPI: 1386886455
Provider Name (Legal Business Name): DANIEL GLEN KELLER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5171 COTTONWOOD ST SOUTH OFFICE BUILDING 8TH FLOOR
MURRAY UT
84107-5704
US

IV. Provider business mailing address

5171 COTTONWOOD ST SOUTH OFFICE BUILDING 8TH FLOOR
MURRAY UT
84107-5704
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-9800
  • Fax: 801-507-9801
Mailing address:
  • Phone: 801-507-9800
  • Fax: 801-507-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number7278583-4101
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: