Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A118158 | CA |
N | 208600000X | Surgeon | A118158 | CA |
Y | 2086S0120X | Pediatric Surgery | A118158 | CA |
NPI | 1285953364 |
---|---|
Provider Name | Benjamin Alan Keller |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2010 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) |