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General NPI Number Information
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NPI Number | 1225168701
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Entity Type | Organization
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Legal Business Name | KELLER & GOODMAN MD, PA
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 1879 NIGHTINGALE LN SUITE C-2
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City | TAVARES
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State | FL
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Zip | 32778-4363
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Country | US
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Telephone | 352-742-7776
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Fax | 352-742-7750
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Provider Business Mailing Address
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Address Line | 1879 NIGHTINGALE LN SUITE C-2
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City | TAVARES
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State | FL
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Zip | 32778-4363
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Country | US
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Telephone | 352-742-7776
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Fax | 352-742-7750
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY ALAN GOODMAN
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Credential | MD
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Telephone | 352-742-7776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME66294
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License Number State | FL
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