Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 34.011623 | OH |
NPI | 1003100082 |
---|---|
Provider Name | Chad Robert Keller |
First Address | Gallipolis, OH 45631-1560 |
Second Address | Chillicothe, OH 45601-7203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2011 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0176981 | (05) | OH |
1003100082 | (05) | WV |