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General NPI Number Information
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NPI Number | 1497780795
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Entity Type | Individual
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Provider Name | LISA KAY KELLER MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 940 ROYAL AVENUE SUITE 350
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City | MEDFORD
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State | OR
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Zip | 97504-6194
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Country | US
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Telephone | 541-732-7460
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Fax | 541-732-7461
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Provider Business Mailing Address
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Address Line | 919 REDDY AVENUE
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City | MEDFORD
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State | OR
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Zip | 97504-7438
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Country | US
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Telephone | 541-245-9116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G38545
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD27247
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License Number State | OR
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