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NPI Code Detail

MEDICARE: STEWART R KELLER DO

MEDICARE: STEWART R KELLER DO
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 PhysicianJ0038TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00279334OTHERMEDICARE RR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18AJ514OTHERTXBCBS
3J0038OTHERTXSTATE LICENSE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881647295
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEWART R KELLER DO
Provider Business Mailing Address
First Line : PO BOX 34629
Second Line :
City : FORT WORTH
State : TX
Zip : 76162-4629
Country : US
Telephone Number : 817-348-8333
Fax Number : 817-348-8415
Provider Business Practice Location Address
First Line : 5560 MESA SPRINGS DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-2120
Country : US
Telephone Number : 817-348-8333
Fax Number : 817-348-8415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 04/10/2020

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