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NPI Code Detail

MEDICARE: TONA J KELLER PA-C

MEDICARE:   TONA J KELLER  PA-C
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
1363A00000XPhysician AssistantPA01832TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DA0825OTHERTXMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10053KDOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1902820780
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONA J KELLER PA-C
Provider Business Mailing Address
First Line : PO BOX 1263
Second Line :
City : DICKINSON
State : TX
Zip : 77539-1263
Country : US
Telephone Number : 409-933-0733
Fax Number : 409-933-9777
Provider Business Practice Location Address
First Line : 6510 MEMORIAL DR
Second Line :
City : TEXAS CITY
State : TX
Zip : 77591-4016
Country : US
Telephone Number : 409-933-0733
Fax Number : 409-933-9777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2006
Last Update Date : 10/30/2007

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Directions to “ TONA J KELLER PA-C” Practice Location

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