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General NPI Number Information
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NPI Number | 1760714810
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Entity Type | Individual
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Provider Name | RYAN JAMES KELLER D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2010
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 9511 ANTILLES DR
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City | SEMINOLE
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State | FL
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Zip | 33776-1402
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Country | US
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Telephone | 303-266-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 9511 ANTILLES DR
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City | SEMINOLE
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State | FL
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Zip | 33776-1402
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Country | US
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Telephone | 303-266-0543
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-121866
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DR.0051234
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License Number State | CO
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