# KELLER DERMATOLOGY, P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588985683
- **Authorized official:** DR. JACK B COHEN D.O. (PRESIDENT)
- **Authorized official phone:** (817) 753-6633

## Contact information

- **Practice address:** 601 S MAIN ST, SUITE 115, KELLER, TX 76248-7029
- **Practice address phone:** (817) 753-6633
- **Practice address fax:** (817) 753-6634
- **Mailing address:** 601 S MAIN ST, SUITE 115, KELLER, TX 76248-7029
- **Mailing address phone:** (817) 753-6633
- **Mailing address fax:** (817) 753-6634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | F6536 | TX | Yes |

## Other

- **Enumeration date:** 06/13/2010
- **Last updated:** 06/13/2010