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NPI Code Detail

MEDICARE: DR. BRADLY J KELLER MD

MEDICARE: DR. BRADLY J KELLER MD
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
12084P0800XPsychiatry PhysicianQ6436TX

General Provider Information

NPI Number : 1265462378
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLY J KELLER MD
Provider Business Mailing Address
First Line : 1515 HERITAGE DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-3256
Country : US
Telephone Number : 972-562-9647
Fax Number : 972-665-0076
Provider Business Practice Location Address
First Line : 1515 HERITAGE DR
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-3256
Country : US
Telephone Number : 972-562-9647
Fax Number : 972-665-0076
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 02/06/2024

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