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General NPI Number Information
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NPI Number | 1619292182
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Entity Type | Individual
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Provider Name | RICHARD KELLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 1235 EAST 200 SOUTH #702 1235 EAST 200 SOUTH #702
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-8410
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Country | US
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Telephone | 801-355-9040
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 EAST 200 SOUTH #702 1235 EAST 200 SOUTH #702
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-8410
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Country | US
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Telephone | 801-355-9040
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 145118-1205
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License Number State | UT
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