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General NPI Number Information
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NPI Number | 1245306810
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Entity Type | Organization
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Legal Business Name | NATHANIEL KELLER MD PA
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Dates
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Enumeration Date | 11/27/2006
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 7469 NW 4TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-2216
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Country | US
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Telephone | 954-792-0772
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Fax | 954-792-1221
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Provider Business Mailing Address
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Address Line | 7469 NW 4TH ST
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City | PLANTATION
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State | FL
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Zip | 33317-2216
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Country | US
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Telephone | 954-792-0772
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Fax | 954-792-1221
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. NATHANIEL KELLER
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Credential | MD
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Telephone | 954-792-0772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME87905
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License Number State | FL
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