MEDICARE: MR. ROY TRUMAN KELLER JR. CFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist

General Provider Information

NPI Number	:	1154496479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROY TRUMAN KELLER JR. CFA

Provider Business Mailing Address
First Line	:	115 E BREARLEY DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85737-6639
Country	:	US
Telephone Number	:	520-797-4657
Fax Number	:

Provider Business Practice Location Address
First Line	:	7320 N LA CHOLLA BLVD
Second Line	:	SUITE #154-218
City	:	TUCSON
State	:	AZ
Zip	:	85741-2309
Country	:	US
Telephone Number	:	520-404-8562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	06/25/2013

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