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General NPI Number Information
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NPI Number | 1417146093
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Entity Type | Organization
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Legal Business Name | BRIAN P. KELLER DPM, INC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 841 STERLING PKWY 130
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City | LINCOLN
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State | CA
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Zip | 95648-7324
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Country | US
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Telephone | 916-434-6410
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Fax | 916-434-6310
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Provider Business Mailing Address
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Address Line | 841 STERLING PKWY 130
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City | LINCOLN
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State | CA
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Zip | 95648-7324
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Country | US
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Telephone | 916-434-6410
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Fax | 916-434-6310
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | BRIAN P KELLER
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Credential | DPM
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Telephone | 916-434-6410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E4185
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License Number State | CA
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