Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME62258 | FL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME62258 | FL |
NPI | 1285638965 |
---|---|
Provider Name | Dr. Gregory C Keller |
First Address | Jacksonville, FL 32207-8566 |
Second Address | Jacksonville, FL 32207-8566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00655069A | (05) | GA |
376096100 | (05) | FL |
F90002 | (02) | FL |