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General NPI Number Information
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NPI Number | 1144520958
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Entity Type | Individual
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Provider Name | JOSEPH WADE KELLER PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/26/2010
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 216-408-6532
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Fax |
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Provider Business Mailing Address
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Address Line | 3450 11TH CT FL 3
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City | VERO BEACH
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State | FL
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Zip | 32960-5012
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Country | US
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Telephone | 216-408-6532
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.003164
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License Number State | OH
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