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General NPI Number Information
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NPI Number | 1710182795
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Entity Type | Individual
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Provider Name | MATTHEW WILLIAM KELLER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | PSC 473 BOX 1674
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City | FPO
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State | AP
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Zip | 96349-0017
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Country | US
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Telephone | 860-885-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 872 EMERALD ST
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City | SAN DIEGO
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State | CA
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Zip | 92109-2712
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Country | US
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Telephone |
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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 | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 01065977A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | A156771
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License Number State | CA
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