Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A128254 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 18249 | HI |
NPI | 1225297997 |
---|---|
Provider Name | Thomas C Keller |
First Address | Kailua, HI 96734-2739 |
Second Address | Kailua, HI 96734-2739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 28/09/2015 |