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General NPI Number Information
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NPI Number | 1295998714
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Entity Type | Organization
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Legal Business Name | BRIDGET J KELLER MD LLC
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 2401 UNIVERSITY PKWY SUITE 204
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City | SARASOTA
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State | FL
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Zip | 34243-2893
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Country | US
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Telephone | 941-379-8830
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Fax | 941-360-0557
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Provider Business Mailing Address
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Address Line | 8374 MARKET ST # 239
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5137
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Country | US
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Telephone | 941-201-2261
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRIDGET JEAN KELLER
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Credential | M.D.
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Telephone | 941-201-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME97313
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License Number State | FL
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