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General NPI Number Information
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NPI Number | 1003942145
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Entity Type | Individual
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Provider Name | SCOTT ROBERT KELLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/25/2007
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 3 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2965
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Country | US
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Telephone | 618-222-9244
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Fax | 618-222-9248
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Provider Business Mailing Address
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Address Line | 3 PARK PL
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City | SWANSEA
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State | IL
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Zip | 62226-2965
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Country | US
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Telephone | 618-222-9244
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Fax | 618-222-9248
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2007011139
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2004014306
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036.132786
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License Number State | IL
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