{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "BRIAN P. KELLER DPM, INC",
"LastName": null,
"FirstName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "841 STERLING PKWY",
"SecondLineMailingAddress": "130",
"MailingAddressCityName": "LINCOLN",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95648-7324",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "916-434-6410",
"MailingAddressFaxNumber": "916-434-6310",
"FirstLinePracticeLocationAddress": "841 STERLING PKWY",
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"PracticeLocationAddressCityName": "LINCOLN",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "916-434-6410",
"PracticeLocationAddressFaxNumber": "916-434-6310",
"EnumerationDate": "10/18/2007",
"LastUpdateDate": "02/04/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KELLER",
"AuthorizedOfficialFirstName": "BRIAN",
"AuthorizedOfficialMiddleName": "P",
"AuthorizedOfficialTitle": "PHYSICIAN OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DPM",
"AuthorizedOfficialTelephoneNumber": "916-434-6410",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "213E00000X",
"TaxonomyName": "Podiatrist",
"LicenseNumber": "E4185",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}